Volume 17,2024 Issue 12

Intelligent Ophthalmology

• Bilateral meibomian gland morphological alterations in unilateral herpes simplex keratitis based on artificial intelligence analysis

  Xin-Xin Yu, Xue-Wen Chen, Qi Dai, Shuang-Qing Wu

  2024,17(12):2153-2157, DOI: 10.18240/ijo.2024.12.01

  Abstract: (12) HTML (0) PDF (710.58 KKB)(14)

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  AIM: To explore whether unilateral herpes simplex keratitis (HSK) can cause morphological changes of bilateral meibomian glands (MGs) based on artificial intelligence (AI) analytical system. METHODS: In the retrospective study, 29 patients with unilateral HSK and 29 participants matched in terms of age and sex were included as control group. Meibographic images of the upper eyelid using Keratograph 5M and assessed ocular surface parameters including tear meniscus height and tear break-up time. MG density and vagueness values were automatically analyzed and calculated using an AI analytical system. We compared the differences between the affected and the contralateral unaffected eyes in HSK patients, and the normal control eyes. We employed either the paired t-test or the Wilcoxon signed-rank test to compare significant difference between the affected and unaffected eyes in HSK patients or between the HSK group and control group. RESULTS: The MG density was 0.19±0.09 in the HSK-affected eye and 0.18±0.07 in contralateral unaffected eye, which had no significant difference (P=0.616). The MG density between the affected eye with HSK and the normal control group was statistically significant (P=0.028). There was a significant difference in MG density between the contralateral unaffected eye and the normal control group (P=0.012). However, no significant difference in vagueness value was observed between the eye with HSK and the control group or between HSK eye and contralateral eye. CONCLUSION: The MG density between the HSK-affected eye and the contralateral unaffected eye don’t significantly differ, whereas there is a significant decrease in the HSK group compared to that of the normal participants. Unilateral HSV keratitis may suffer from bilateral changes of MG morphology indicating bilateral dry eye. Therefore, the fellow eye of patients with unilateral HSK should be considered a potential case of MG dysfunction, necessitating early treatment for bilateral dry eye in the clinic.

Basic Research

• Alkali burn injury model of meibomian gland dysfunction in mice

  Yong Li, Ya-Qiong Yang, Yong Lin, Ke Yan, Yu-Fei Lyu, Zhao-Qiang Zhang, Cai-Hong Huang, Jiao-Yue Hu, Zu-Guo Liu

  2024,17(12):2158-2166, DOI: 10.18240/ijo.2024.12.02

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  AIM: To establish a stable, short-time, low-cost and reliable murine model of meibomian gland dysfunction (MGD). METHODS: A filter paper sheet soaked in 1.0 mol/L sodium hydroxide (NaOH) solution was used to touch the eyelid margin of C57BL/6J mice for 10s to establish the model. The other eye was left untreated as a control group. Eyelid margin morphological changes and the meibomian glands (MGs) were observed by slit lamp microscopy on days 5 and 10 post-burn. Hematoxylin-eosin (HE) staining and Oil red O staining were adopted in detecting the changes in MGs morphology and lipid deposition. Real-time polymerase chain reaction, Western blot, immunofluorescence staining and immunohistochemical staining were used to detect interleukin (IL)-6, IL-1β, IL-18, tumor necroses factor (TNF)-α, interferon (IFN)-γ, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 4 (NOX4), 3-nitroturosine (3-NT), 4-hydroxynonenal (4-HNE) and cytokeratin 10 (K10) expression changes in MGs. RESULTS: MGs showed plugging of orifice, glandular deficiency, abnormal acinar morphology, ductal dilatation, and lipid deposition after alkali burn. The expressions of IL-6, IL-18, IL-1β, IFN-γ, and TNF-α indicators of inflammation and oxidative stress in MGs tissues were significantly increased. Abnormal keratinization increased in the MG duct. CONCLUSION: A murine model of MGD is established by alkali burn of the eyelid margin that matches the clinical presentation of MGD providing a stable, short-time, low-cost, and reliable MGD model. The new method suggests efficient avenues for future research.

• Biocompatibility of light responsive materials prepared for accommodative intraocular lenses manufacturing

  Chen-Zi Liu, Ming-Hao Sun, Wei Dai, Lan-Cao Hao, Si-Quan Zhu

  2024,17(12):2167-2176, DOI: 10.18240/ijo.2024.12.03

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  AIM: To investigate the biocompatibility and bacterial adhesion properties of light responsive materials (LRM) and analyze the feasibility and biosafety of employing LRM in the preparation of accommodative intraocular lenses (AIOLs). METHODS: Employing fundamental experimental research techniques, LRM with human lens epithelial cells (hLECs) and human retinal pigment epithelium cells (ARPE-19 cells) were co-cultured. Commercially available intraocular lenses (IOLs) were used as controls to perform cell counting kit-8 (CCK-8), cell staining under varying light intensities, cell adhesion and bacterial adhesion experiments. RESULTS: LRM exhibited a stronger inhibitory effect on the proliferation of ARPE19 cells than commercially available IOLs when co-cultured with the undiluted extract for 96h (P<0.05). Under other culturing conditions, the effects on the proliferation of hLECs and ARPE-19 cells were not significantly different between the two materials. Under the influence of light irradiation at intensities of 200 and 300 mW/cm2, LRM demonstrated a markedly higher inhibitory effect on the survival of hLECs compared to commercially available IOLs (P<0.0001). They also showed a stronger suppressive effect on the survival rate of ARPE-19 cells, with significant differences observed at 200 mW/cm2 (P<0.001) and extremely significant differences at 300 mW/cm2 (P<0.0001). Additionally, compared to commercially available IOLs, LRM had a higher number of cells adhering to their surface (P<0.05), as well as a significantly greater number of adherent bacterium (P<0.0001). CONCLUSION: LRM, characterized by their excellent non-contact tunable deformability and low cytotoxicity to ocular tissues, show considerable potential for use in the fabrication of AIOLs. These materials demonstrate strong cell adhesion; however, during photothermal conversion processes involving shape deformation under various light intensities, the resultant temperature rise may harm surrounding cells. These factors suggest that while the material plays a positive role in reducing the incidence of posterior capsule opacification (PCO), it also poses potential risks for retinal damage. Additionally, the strong bacterial adhesion of these materials indicates an increased risk of endophthalmitis.

• Modeling monocular form deprivation in rabbits using a simulated-cataract intraocular lens

  Si-Yi Gu, Li-Ming Xu, Wei-Jie Sun, Li-Li Liang, Lei Lin, Han Zou, Jing-Yuan Xu, Yu Zheng, Yuan-Yuan Li, Yin-Ying Zhao, Ping-Jun Chang, Yun-E Zhao

  2024,17(12):2177-2184, DOI: 10.18240/ijo.2024.12.04

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  AIM: To establish an animal model of form deprivation amblyopia based on a simulated cataract intraocular lens (IOLs). METHODS: Poly(dimethyl siloxane)-SiO2 thin films (PSF) with different degrees of opacity as IOL materials were prepared. The light transmission of the PSF-IOL was measured, and its in vitro biosafety was determined by cell counting kit (CCK)-8 assay using the HLEC-B3 cell line and ARPE-19 cell line. Subsequently, the in vivo safety was determined by implanting the PSF-IOL with 10% wt SiO2 into the right eyes of New Zealand white rabbits (PSF-IOL group), and compared with two control groups: contralateral comparison group and normal control (NC) group (Contralateral comparison group: the fellow eye; NC group: a group of binocular normal rabbits without intervention). The flash visual-evoked potentials (F-VEPs) were measured to verify amblyopia. RESULTS: PSFs containing 0, 2%, and 10% wt SiO2 were successfully constructed. The 0 SiO2 PSF was transparent, while the 10% wt SiO2 PSF was completely opaque. It was found that PSF did not induce unwanted cytotoxicity in HLECs and ARPE19 cells in vitro. In vitro, PSF-IOL with 10% wt SiO2 was also non-toxic, and no significant inflammation or structural changes occurred after four weeks of PSF-IOL implantation. Finally, our IOL-simulated congenital cataract rabbit detected by F-VEPs suggested tentative amblyopia. CONCLUSION: A PSF-IOL that mimics cataracts is created. A novel form deprivation model is created by the IOL-simulated congenital cataract rabbit. It can be developed fast and stable and holds great potential for future study.

• Analysis of SMOC2 gene variants in familial and non-familial primary open angle glaucoma Pakistani patients

  Ashok Kumar Narsani, Feriha Fatima Khidri, Muhammad Rafiq, Jalpa Bai, Hina Shaikh, Yar Muhammad Waryah, Syed Habib Ahmed Naqvi, Preety Kumari, Mahesh Kumar Lohano, Ali Muhammad Waryah

  2024,17(12):2185-2191, DOI: 10.18240/ijo.2024.12.05

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  AIM: To find out the association of secreted protein acidic and rich in cysteine (SPARC)-related modular calcium binding 2 (SMOC2) gene variants rs2255680 and rs13208776 with genotypic and phenotypic characteristics in both familial and non-familial primary open angle glaucoma (POAG) patients. METHODS: A total of 212 POAG patients, comprising 124 familial and 88 non-familial, were enrolled. For genotyping the SMOC2 variant rs2255680, amplification refractory mutation system (ARMS)-polymerase chain reaction (PCR) method and PCR-restriction fragment length polymorphism (PCR-RFLP) were utilized for analyzing rs13208776 variant. RESULTS: The mean age of familial POAG patients was 50.92±9.12y, with 78 males and 46 females. The mean age of non-familial POAG patients was 53.14±13.44y, with 52 males and 36 females. The SMOC2 gene variant rs13208776 showed the significant association with POAG between familial and non-familial groups. The homozygous G/G variant was frequent among non-familial (60.2%) whereas the heterozygous G/A variant was more frequent in familial POAG patients (46%). There were significant differences in G/A variant between familial and non-familial glaucoma patients, and the risk was decreased to 0.53-fold in non-familial glaucoma patients [odds ratio (OR): 0.53; 95% confidence interval (CI): 0.29-0.94; P=0.033] in codominant model. The risk was further reduced to 0.49-fold (95%CI: 0.28-0.86; P=0.012) in dominant model for non-familial patients. No significant association of SMOC2 gene variant rs2255680 between familial and non-familial glaucoma patients was found in our population. The haplotype analysis showed the decreased risk for TA [OR: 0.48 (95%CI: 0.29-0.79); P=0.004] and an increased risk for TG [OR=2.28 (95%CI: 1.22-4.25); P=0.01] haplotypes. CONCLUSION: Current findings show significant association of SMOC2 gene variant rs13208776 with POAG between familial and non-familial Pakistani patients.

• Morphological and functional observations of a novel model of retinal ischemia injury induced by bilateral carotid artery stenosis in mice

  Lian Shu, You-Jia Zhang, Xiao-Xiao Chen, Xing-Huai Sun

  2024,17(12):2192-2202, DOI: 10.18240/ijo.2024.12.06

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  AIM: To investigate the features of retinal ischemic injuries in a novel mouse model with bilateral carotid artery stenosis (BCAS). METHODS: BCAS was induced with microcoil implantation in 6-8-week-old C57BL6 mice. Cerebral blood flow was monitored at 2, 7, and 28d postoperatively. Retinal morphological changes were evaluated by fundus photography and hematoxylin-eosin staining. Fluorescein fundus angiography (FFA) was performed to detect retinal vascular changes and circulation. The levels of apoptosis, activation of neurogliosis, and expression of hypoxia-inducible factor (HIF)-1α in the retina were assessed by Western blotting and immunofluorescence staining, followed by retinal ganglion cell (RGC) density detection. Additionally, electrophysiological examinations including photopic negative response (PhNR) was also performed. RESULTS: The mice demonstrated an initial rapid decrease in cerebral blood flow, followed by a 4-week recovery period after BCAS. The ratio of retinal artery and vein was decreased under fundus photography and FFA. Compared with the sham mice, BCAS mice showed thinner retinal thickness on day 28. Additionally, apoptosis was increased and RGC density was decreased mainly in peripheral retinal region. Neurogliosis was mainly located in the inner retinal layers, with a stable increase in HIF-1α expression. The dark-adapted electroretinogram showed a notable reduction in the a-, b-, and oscillatory potential (OP) wave amplitudes between days 2 and 7; this gradually recovered over the following 4wk. However, the b- and OP-wave amplitudes were still significantly decreased on PhNR examination on day 28. CONCLUSION: BCAS can result in relatively mild retinal ischemia injuries in mice, mainly in the inner layer and peripheral region. Our study provides a novel animal model for investigating retinal ischemic diseases.

Clinical Research

• Guidelines for the standardized diagnosis and treatment of non-specific orbital inflammation (2024)

  Yi Shao, Jian-Min Ma, Hua-Sheng Yang, Expert Workgroup of Guidelines for Diagnosis, Treatment of Nonspecific Orbital Inflammation (2024), Ophthalmic Imaging, Intelligent Medicine Branch Chinese Medicine Education Association, Ocular Oncology Committee of the Ophthalmology Branch of the Chinese Medical Doctor Association, Ophthalmology Committee of International Association of Translational Medicine, Ophthalmology Committee of International Association of Intelligent Medicine, Chinese Ophthalmic Imaging Study Groups

  2024,17(12):2203-2213, DOI: 10.18240/ijo.2024.12.07

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  Non-specific orbital inflammation (NSOI) is a non-infectious orbital inflammation. Although it is often considered the most common diagnosis in orbital biopsies, it is an exclusionary diagnosis that requires ruling out systemic disease or other possible causes. Its characteristics include acute orbital signs and symptoms, including pain, proptosis, periorbital edema, chemosis, diplopia, and visual impairment. The clinical manifestations and histological findings of NSOI are heterogeneous, without specific diagnostic criteria or treatment guidelines, which poses significant challenges for diagnosis and treatment. This guideline provides a detailed description of the definition, classification, diagnosis, and treatment of NSOI.

• Influencing factors of ocular pain in dry eye disease patients at high altitude

  Peng-Cheng Zhang, Wen-Shan Jiang, Ya-Zhen Wu, Han-Jing Dai, Dan Wang, Yu-Meng Bao, Hong Yan

  2024,17(12):2214-2220, DOI: 10.18240/ijo.2024.12.08

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  AIM: To quantify the severity and frequency of ocular pain in Tibetan plateau patients with dry eye, and to evaluate the related factors affecting ocular pain. METHODS: A retrospective study included 160 cases of dry eye disease (DED) patients who were treated from July 2022 to June 2023. Age, gender, occupation, illness course, anxiety, plateau duration, plateau protection, ocular surface disease index scale (OSDI), break-up time (BUT), Schirmer I test (SIT), conjunctivitis, history of ophthalmic medication, autoimmune disease, the workload of daily near vision range, smoking and overnight stay were obtained via comprehensive ophthalmic assessment, and their duration was followed up. Logistic regression analysis was used to determine the related factors affecting ocular pain. RESULTS: Totally 77.5% (124/160) of DED patients had ocular pain, of which the severity of ocular pain was mild, moderate, and severe in 30.0%, 36.3%, and 11.3% of patients, respectively. Frequency of ocular pain was reported occasional, half the time, frequent, and persistent pain in 19.4%, 36.9%, 16.9%, and 4.4%. OSDI score was 19.67±5.70 (13 to 36), and the level of pain was lowly correlated with OSDI (rs=0.316, P<0.001). Logistic regression showed that in plateau DED patients, increased anxiety led to increased severity and frequency of ocular pain [odds ratio (OR)=3.662, 5.613, 2.387, and 4.870; all P<0.05], professional eye protection and improvement of daily sleep quantity decreased pain (OR=0.307, 0.572, 0.418, and 0.789; all P<0.05), while smoking and general protection of plateau did not affect the severity and frequency of ocular pain (all P>0.05). CONCLUSION: Ocular pain is a common complaint in high-altitude DED patients during the pandemic. Anxiety, eye protection, and adequate sleep during the epidemic period are significantly associated with the severity and frequency of ocular pain in patients with plateau DED, while symptoms of DED have relatively little influence on them.

• Treatment of superficial corneal opacities with corneal stromal lenticule obtained through SMILE surgery

  Shi-Si Hu, Hui Ding, Xu-Yun Meng, Bo-Wen Ouyang, Zhen-Duo Yang, Xiao-Dan Chen, Xing-Wu Zhong

  2024,17(12):2221-2228, DOI: 10.18240/ijo.2024.12.09

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  AIM: To evaluate the clinical efficacy and feasibility of superficial corneal opacities treated by excimer laser phototherapeutic keratectomy (PTK) combined with small incision lenticule extraction (SMILE)-derived corneal stromal lenticule transplantation. METHODS: A retrospective interventional case series of nine patients aged 12–59y with superficial corneal opacity caused by different pathologies who underwent standardized PTK combined with SMILE-derived corneal stromal lenticule transplantation was examined. Lenticule patches were fixed with fibrin glue. All patients underwent pre- and post-operative clinical assessments at different times for up to 12mo. Slit lamp microscopy, corneal density, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and anterior segment optical coherence tomography (AS-OCT) were examined. RESULTS: The patients’ mean age was 36.00±5.80 (12–59)y. Seven eyes (77.8%) gained UDVA and CDVA at the last measurement compared to their preoperative levels. The densities of the total cornea, the total anterior corneal layer, and the anterior corneal layers of 0–2 and 2–6 mm decreased significantly by 12.4%, 27.5%, 46.7%, and 32.8%, respectively. After human allogeneic transplantation, the implanted lenticules of all eyes were clearly visible by AS-OCT and remained transparent without displacement or graft rejection. The thickness of the central cornea and corneal lenticule transplants were stable throughout the entire postoperative period. One case experienced the postoperative complication of delayed corneal epithelial healing. CONCLUSION: PTK combined with SMILE-derived corneal lenticule transplantation improves long-term visual acuity. Therefore, it is a new, safe, and effective method for treating superficial corneal opacity.

• Efficacy of mycophenolate mofetil combined with topical 0.05% tacrolimus in high-risk keratoplasty: 1-year cohort study

  Jin-Yu Zhang, Kang Yu, Xiu-Ying Jiang, Jia-Xin Liang, Shi-You Zhou

  2024,17(12):2229-2235, DOI: 10.18240/ijo.2024.12.10

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  AIM: To investigate the efficacy of systemic mycophenolate mofetil (MMF) as an adjunct in combination with topical tacrolimus (FK506) and corticosteroid eyedrops for preventing corneal graft rejection after high-risk keratoplasty (HRK). METHODS: In this cohort study, 55 consecutive patients (55 eyes) from an eye center who met the criteria of HRK were included. The definition for HRK includes large grafts of no less than 9 mm diameter, vascularized cornea of two or more quadrants, regrafting, or eccentric grafts. After penetrating keratoplasty, 25 patients treated with systemic MMF in combination with 0.05% FK506 and tapering corticosteroid eyedrops were enrolled in Group 1 from October 2019. Thirty patients receiving postoperative treatment with 0.05% FK506 and tapering corticosteroid eyedrops alone were enrolled in Group 2 from January 2018 to September 2019. All participants were closely monitored after surgery, and episodes of graft rejection and relevant clinical data were collected and assessed over a one-year follow-up period. RESULTS: After a follow-up of 9.6±3.2mo, graft rejection episodes occurred in 4 cases (16%) in Group 1 and 18 cases (60%) in Group 2. One reversible and 3 irreversible graft rejections occurred in Group 1, while 3 reversible and 15 irreversible rejections occurred in Group 2. Kaplan–Meier analysis revealed that 82.5% of grafts in Group 1 and 37.1% in Group 2 did not experience corneal graft rejection (P<0.01, log-rank test). The clear graft survival rate was 83.6% in Group 1 and 36.7% in Group 2 (P<0.01, log-rank test) within one year of follow-up. No severe systemic side effects were observed in either group during the follow-up period. CONCLUSION: The triple treatment regimen consisting of MMF, topical FK506, and corticosteroid eyedrops represents a promising strategy for effectively preventing graft rejection and improving graft survival in patients with HRK.

• Refraction difference value variations in children and adolescents with different refractive errors

  Da-Wen Wu, Ze-Yi Yang, Yan Nie, He-Ya Ye, Liang Chen, Long-Qian Liu, Guo-Yuan Yang

  2024,17(12):2236-2242, DOI: 10.18240/ijo.2024.12.11

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  AIM: To evaluate the refraction difference value (RDV) variations in children and adolescents with different refractive errors and analyze its correlation with refractive development. METHODS: Participants aged 4-16y with different refractive statuses (hyperopia, emmetropia, myopia) underwent comprehensive eye examinations, including spherical equivalent (SE) refraction, axial length (AL), total RDV (TRDV), and RDVs at various eccentricities (0°-15°, 15°-30°, 30°-45°) and quadrants (inferior, superior, nasal, temporal). Statistical analysis involved one-way ANOVA for group comparisons and Pearson correlation for examining relationships between SE/AL and RDVs. Paired t-tests compared quadrant-specific RDVs within groups. RESULTS: Significant difference was found in TRDV (P<0.001), RDV15°-30° (P=0.033), RDV30°-45° (P<0.001), RDV-inferior (RDV-I, P<0.001) and RDV-temporal (RDV-T, P<0.001) among hyperopia, emmetropia and myopia group. Pearson correlation analysis revealed a negative correlation of SE with TRDV (P=0.001), RDV30°-45° (P=0.004), RDV-I (P=0.047), and RDV-T (P<0.001). The differences between RDV-superior (RDV-S) and RDV-I were statistically significant in all groups (P<0.001 for all) and between RDV-T and RDV-nasal (RDV-N) were statistically significant in hyperopia group (P<0.001). Within the pre-myopic group, the analysis revealed a negative correlation of SE with RDV-I (P=0.009). Pearson correlation analysis revealed a positive correlation of AL with TRDV (P=0.036), RDV15°-30° (P=0.004), RDV30°-45° (P<0.001), RDV-S (P=0.003), RDV-I (P<0.001), RDV-T (P<0.001), RDV-N (P=0.022), while revealed a negative correlation of AL with RDV0-15° (P=0.018). CONCLUSION: Our study indicates TRDV, RDV30°-45°, RDV-I, RDV-T may relate to refractive development, and a negative correlation between SE and RDV-I in pre-myopic children.

• Effect of astigmatism and spherical equivalent correction on contrast sensitivity

  Maryam Saffarizadeh, Saeed Rahmani, Alireza Akbarzadeh Baghban, Mohammad Ghassemi-Broumand

  2024,17(12):2243-2247, DOI: 10.18240/ijo.2024.12.12

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  AIM: To investigate the effect of astigmatism and spherical equivalent (SE) correction on contrast sensitivity (CS). METHODS: In this cross-sectional study, 103 visually normal subjects aged 18 to 36y with bilateral regular astigmatism in range of 1.00 diopter cylinder (DC) to 4.00 DC and normal best-corrected visual acuity (20/20) were recruited. Binocular CS was assessed by linear sine-wave gratings at 1.5, 3, 6, 12, and 18 cycles per degree (cpd), before correction of astigmatism, after full correction of astigmatism by cylindrical spectacle lenses, and after SE of refractive error. The repeated measures ANOVA and Bonferroni test were used to compare the effects of astigmatism correction on logCS. RESULTS: Totally 39 patients were male and 64 patients were female with the mean age of 28.25±5.38y. The average degree of astigmatism in right and left eye was 2.03±0.83 and 2.10±0.78, respectively. Increases in uncorrected astigmatic power correlated with decreases in the logCS, especially at high spatial frequencies. A statistically significant difference in logCS was found between these three cases: before correction of astigmatism, after SE of refractive error, and after full correction of astigmatism by cylindrical spectacle lenses at all frequencies (P<0.001), except at 18 cpd. At 18 cpd, there was no statistically significant difference between logCS before and after SE of refractive error (P=1.0). Also, there was no statistically significant difference in mean CS between with-the-rule (WTR) and against-the-rule (ATR) astigmatism, before correction of astigmatism, after correction of astigmatism with cylindrical lenses, and after SE of refractive error. CONCLUSION: Binocular astigmatism defocus decreases CS depending on the degree of astigmatism power; correction of this will improve patent’s quality of vision. Although high astigmatism refractive error (more than 2.00 DC) that is fully corrected by cylindrical spectacle lenses doesn’t increase the CS to the maximum value, especially at higher spatial frequencies (12 and 18). Also SE refractive error effects on improving CS in low astigmatism power (less than 2.00 DC), especially at lower spatial frequencies.

• Functional connectivity of paired default mode network subregions in patients with eye trauma

  Zheng-Mao Xing, Dan Song, Jin-Yu Hu, Xian-Mei Zhou, Xuan Liao, Cheng Chen, Hong Wei, Min Kang, Qian Ling, Liang-Qi He, Zhen-Zhe Liu, Jie Zou, Xu Chen, Zhen-Kai Wu, Yi Shao

  2024,17(12):2248-2255, DOI: 10.18240/ijo.2024.12.13

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  AIM: To study functional brain abnormalities in patients with eye trauma (ET) and to discuss the pathophysiological mechanisms of ET. METHODS: Totally 31 ET patients and 31 healthy controls (HCs) were recruited. The age, gender, and educational background characteristics of the two groups were similar. After functional magnetic resonance imaging (fMRI) scanning, the subjects’ spontaneous brain activity was evaluated with the functional connectivity (FC) method. Receiver operating characteristic (ROC) curve analysis was used to classify the data. Pearson’s correlation analysis was used to explore the relationship between FC values in specific brain regions and clinical behaviors in patients with ET. RESULTS: Significantly increased FC between several regions was identified including the medial prefrontal cortex (MPFC) and left hippocampus formations (HF), the MPFC and left inferior parietal lobule (IPL), the left IPL and left medial temporal lobe (MTL), the left IPL and right MTL, and the right IPL and left MTL. No decreased region-to-region connectivity was detected in default mode network (DMN) sub-regions in patients with ET. Compared with HCs, ET patients exhibited significantly increased FC between several paired DMN regions, as follows: posterior cingulate cortex (PCC) and right HF (HF.R, t=2.196, P=0.032), right inferior parietal cortices (IPC.R) and left MTL (MTL.L, t=2.243, P=0.029), and right MTL (MTL.R) and HF.R (t=2.236, P=0.029). CONCLUSION: FC values in multiple brain regions of ET patients are abnormal, suggesting that these brain regions in ET patients may be dysfunctional, which may help to reveal the pathophysiological mechanisms of ET.

• Endoscopy-assisted vitrectomy for severe ocular penetrating trauma with corneal opacity

  Yong-Zhen Yu, Liu-Lian Jian, Wen-Xiao Chen, Liang-Hong Peng, Yu-Ping Zou, Long Pang, Xiu-Lan Zou

  2024,17(12):2256-2264, DOI: 10.18240/ijo.2024.12.14

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  AIM: To assess the utility and efficiency of endoscopy-assisted vitrectomy (EAV) for the treatment of corneal opacity in severe ocular trauma. METHODS: Patients who underwent fundus examination using a preoperative slit lamp and intraoperative endoscopy, followed by EAV and additional surgery were retrospectively recruited. Silicone oil removal and penetrating keratoplasty were used in selected eyes at postoperative follow-ups. Outcome measurements included the best corrected visual acuity (BCVA), intraocular pressure (IOP), findings of endoscopic fundus examination, and postoperative complications. RESULTS: Twenty-one eyes with severe ocular trauma and corneal opacity were followed up for 24–36mo. Retinal detachment (RD) and vitreous haemorrhage (VH) were identified in 16 eyes (76.2%), RD only in four eyes (19.0%), and VH combined with intraocular foreign body in one eye (4.8%). All eyes underwent at least three surgeries. Stage-I surgeries involved wound closure (100%), lens extraction (76.2%), and anterior vitrectomy (14.3%). Stage-II surgeries involved scleral buckling (28.6%), membrane peeling (47.6%), retinal laser photocoagulation (100%) and silicone oil tamponade (100%) using EAV. Stage-III surgeries were conducted using endoscopy including silicone oil removal (52.4%), retinal laser photocoagulation (52.4%) and penetrating keratoplasty (28.6%). Nearly all eyes showed improvements in BCVA and IOP. Although there were no severe complications, glaucoma was noted in one eye, chronic hypotony in another eye, and band keratopathy in three eyes. CONCLUSION: EAV is an effective adjunct for restoring ocular anatomical structures and visual function in the case of corneal opacity after severe ocular trauma.

• Predictive value of CA-153, CA-125 and Apo A for ocular metastasis in menopausal female patients with breast cancer

  Qun-Ce Liu, Qian Ling, Yan-Mei Zeng, Cheng Chen, Hong Wei, Jin-Yu Hu, Jie Zou, Xiao-Yu Wang, Xu Chen, Yi Shao

  2024,17(12):2265-2275, DOI: 10.18240/ijo.2024.12.15

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  AIM: To establish a meaningful standard for diagnosing ocular metastasis (OM) in menopausal breast cancer (BC) women, and explore the relationship between CA-153, CA-125, apolipoprotein A, and OM. METHODS: A total of 1362 menopausal female BC patients with OM volunteered to take part in this study between July 2012 and July 2022. Women with BC who are menopausal were found to have an OM incidence of 1.6%. Furthermore, CA-153, CA-125, and apolipoprotein A (Apo A) all contributed to OM in women with BC who are postmenopausal according to binary logistic regression. Receiver operating curve (ROC) analysis was used to assess the diagnostic value of OM in patients with BC. RESULTS: Both CA-153 and CA-153+CA-125 showed a higher sensitivity of 95.45%, whereas CA-153+Apo A illustrated the highest specificity of 99.02%. Moreover, CA-153 and CA-153+CA-125 had higher areas under the curve (AUC) of 0.973. CONCLUSION: The data indicate that the serum concentrations of CA-153 exhibited the most significant predictors of the diagnosis of OM in menopausal women with BC. The current study researches the utility of risk factors in predicting of OM in menopausal BC women and put forward the latest suggestions on their clinical application.

• Monocyte to high-density lipoprotein cholesterol ratio as a predictor of the activity of thyroid-associated ophthalmopathy

  Xing-Hong Sun, Xiao-Wen Zhang, Chen Han, Xin Dou, Xue-Ying He, Meng-Ru Su, Feng Jiang, Song-Tao Yuan

  2024,17(12):2276-2281, DOI: 10.18240/ijo.2024.12.16

  Abstract: (2) HTML (0) PDF (784.36 KKB)(7)

  Abstract:

  AIM: To evaluate the relationship between monocyte to high-density lipoprotein cholesterol ratio (MHR) and the disease activity of thyroid-associated ophthalmopathy (TAO). METHODS: A total of 87 patients were classified into two groups based on clinical activity score (CAS) scoring criteria: high CAS group (n=62, the CAS score was ≥3); low CAS group (n=25, the CAS score was <3). In addition, a group of healthy people (n=114) were included to compared the MHR. Proptosis, MHR, average signal intensity ratio (SIR), average lacrimal gland (LG)-SIR, average extraocular muscles (EOM) area from 87 patients with TAO were calculated in magnetic resonance imaging (MRI), and compared between these two groups. Correlation testing was utilized to evaluate the association of parameters among the clinical variables. RESULTS: Patients in high CAS group had a higher proptosis (P=0.041) and MHR (P=0.048). Compared to the healthy group, the MHR in the TAO group was higher (P=0.001). Correlation testing declared that CAS score was strongly associated with proptosis and average SIR, and MHR was positively associated with CAS score, average SIR, and average LG-SIR. The area under the receiver operating characteristic curve (AUC) of MHR was 0.6755. CONCLUSION: MHR, a novel inflammatory biomarker, has a significant association with CAS score and MRI imaging (average SIR and LG-SIR) and it can be a new promising predictor during the active phase of TAO.

Investigation

• Resistant corneal ulcers in a tertiary care ophthalmic center in Egypt: 10 years epidemiological study

  Mohammad M. Khater, Mohammad Hosny Nassef, Mohamed Sameh Elshorbagy

  2024,17(12):2282-2287, DOI: 10.18240/ijo.2024.12.17

  Abstract: (1) HTML (0) PDF (566.19 KKB)(7)

  Abstract:

  AIM: To investigate the magnitude of problem caused by resistant corneal ulcers and its epidemiological characteristics. METHODS: Patients with corneal lesions were selected and carefully examined and cases with resistant corneal ulcers were further investigated and data were recorded using a specific data sheet designed in hospital. Then, collected data from patients were statistically analyzed. RESULTS: Totally 1939 cases were included in the study, including 816 fungal cases (42.1%) and 1123 (57.9%) non-fungal cases. Age of the participants ranged from 18 to 73y. Fungal cases were more common in middle age (35–55y). Men were more affected (53.5%) of cases included in the study. Keratomycosis affected more unskilled personnel (75.1%), large families with small houses (higher crowding index 73.9%), rural (64.5%) residence. Patients with sanitary water sources (34.8%) and waste disposal (24.4%) were less affected. CONCLUSION: Keratomycosis is more frequent in unskilled personnel, rural locations, outdoor water sources and insanitary waste disposal systems. Corneal trauma and contact lens are common risk factors.

• Prevalence of refractive errors in school-aged and preadolescent children in Colombia

  Diana Garcia-Lozada, Diana Valeria Rey-Rodríguez, Sara Viviana Angulo-Sánchez, Jenny Maritza Sánchez-Espinosa

  2024,17(12):2288-2294, DOI: 10.18240/ijo.2024.12.18

  Abstract: (74) HTML (0) PDF (875.56 KKB)(30)

  Abstract:

  AIM: To describe the distribution of refractive errors by age and sex among schoolchildren in Soacha, Colombia. METHODS: This was an observational cross-sectional study conducted in five urban public schools in the municipality of Soacha. A total of 1161 school-aged and pre-adolescent children, aged 5-12y were examined during the school year 2021-2022. Examinations included visual acuity and static refraction. Spherical equivalent (SE) was analysed as follows: myopia SE≤-0.50 D and uncorrected visual acuity of 20/25 or worse; high myopia SE≤-6.00 D; hyperopia SE≥+1.00 D (≥7y) or SE≥+2.00 D (5-6y); significant hyperopia SE≥+3.00 D. Astigmatism was defined as a cylinder in at least one eye ≥1.00 D (≥7y) or ≥1.75 D (5-6y). If at least one eye was ametropic, children were classified according to the refractive error found. RESULTS: Of the 1139 schoolchildren included, 50.6% were male, 58.8% were aged between 5 and 9y, and 12.1% were already using optical correction. The most common refractive error was astigmatism (31.1%), followed by myopia (20.8%) and hyperopia (13.1%). There was no significant relationship between refractive error and sex. There was a significant increase in astigmatism (P<0.001) and myopia (P<0.0001) with age. CONCLUSION: Astigmatism is the most common refractive error in children in an urban area of Colombia. Emmetropia decreased and myopia increased with age.

Bibliometric Research

• Artificial intelligence applications in ophthalmic optical coherence tomography: a 12-year bibliometric analysis

  Ruo-Yu Wang, Si-Yuan Zhu, Xin-Ya Hu, Li Sun, Shao-Chong Zhang, Wei-Hua Yang

  2024,17(12):2295-2307, DOI: 10.18240/ijo.2024.12.19

  Abstract: (5) HTML (0) PDF (2.04 MKB)(9)

  Abstract:

  AIM: To explore the current application and research frontiers of global ophthalmic optical coherence tomography (OCT) imaging artificial intelligence (AI) research. METHODS: The citation data were downloaded from the Web of Science Core Collection database (WoSCC) to evaluate the articles in application of AI in ophthalmic OCT published from January 1, 2012 to December 31, 2023. This information was analyzed using CiteSpace 6.2.R2 Advanced software, and high-impact articles were analyzed. RESULTS: In general, 877 articles from 65 countries were studied and analyzed, of which 261 were published by the United States and 252 by China. The centrality of the United States is 0.33, the H index is 38, and the H index of two institutions in England reaches 20. Ophthalmology, computer science, and AI are the main disciplines involved. Hot keywords after 2018 include deep learning (DL), AI, macular degeneration, and automatic segmentation. CONCLUSION: The annual number of articles on AI applications in ophthalmic OCT has grown rapidly. The United States holds a prominent position. Institutions like the University of California System and the University of London are spearheading advancements. Initial researches centered on the automatic recognition and diagnosis of ocular diseases leveraging traditional machine learning (ML) technology and OCT images. Nowadays, the imaging process algorithm selection has shifted its focus towards DL. Concurrently, optical coherence tomography angiography (OCTA) and computer-aided diagnosis (CAD) have emerged as key areas of contemporary research.

Review Article

• Development and research status of intelligent ophthalmology in China

  Di Gong, Wang-Ting Li, Xiao-Meng Li, Cheng Wan, Yong-Jin Zhou, Shu-Jun Wang, Jian-Tao Wang, Yan-Wu Xu, Shao-Chong Zhang, Wei-Hua Yang

  2024,17(12):2308-2315, DOI: 10.18240/ijo.2024.12.20

  Abstract: (13) HTML (0) PDF (402.74 KKB)(13)

  Abstract:

  This paper analyzes the current status, technological developments, academic exchange platforms, and future challenges and solutions in the field of intelligent ophthalmology (IO) in China. In terms of technology, significant progress has been made in various areas, including diabetic retinopathy, fundus image analysis, quality assessment of medical artificial intelligence products, clinical research methods, technical evaluation, and industry standards. Researchers continually enhance the safety and standardization of IO technology by formulating a series of clinical application guidelines and standards. The establishment of domestic and international academic exchange platforms provides extensive collaboration opportunities for professionals in various fields, and various academic journals serve as publication platforms for IO research. However, challenges such as technological innovation, data privacy and security, lagging regulations, and talent shortages still pose obstacles to future development. To address these issues, future efforts should focus on strengthening technological research and development, regulatory framework construction, talent cultivation, and increasing patient awareness and acceptance of new technologies. By comprehensively addressing these challenges, IO in China is poised to further lead the industry’s development on a global scale, bringing more innovation and convenience to the field of ophthalmic healthcare.

Brief Report

• Characteristics of corneal aberration in patients with bilateral keratoconus and unilateral corneal Vogt’s striae

  Sheng-Sheng Wei, Yong Li, Zhi-Qing Wu, Jian-Guo Liu, Jing Du, Jing Li, Yao-Hua Zhang

  2024,17(12):2316-2320, DOI: 10.18240/ijo.2024.12.21

  Abstract: (5) HTML (0) PDF (861.34 KKB)(9)

  Abstract:

  AIM: To assess the corneal high-order aberration (HOA) and its correlation with corneal morphological parameters in patients with bilateral keratoconus (KCN) and unilateral Vogt’s striae. METHODS: A total of 168 eyes of 84 patients with KCN, whose corneas had definite signs of unilateral Vogt’s striae, were enrolled. Corneal HOA and morphological parameters were measured using Pentacam HR. RESULTS: The corneal morphological parameters between KCN eyes with and without Vogt’s striae were evidently different (P<0.001). The 3rd coma 90°, 4th spherical aberration, 5th coma 90°, root-mean-square (RMS) (total), and RMS (HOA) in the front, back surfaces and total cornea in KCN eyes with Vogt’s striae were significantly higher than those in KCN eyes without Vogt’s striae (P<0.001). In KCN eyes with Vogt’s striae, the 3rd coma 90° and 4th spherical aberration in the front surface and total cornea were negatively correlated with flat keratometry value (K1), steep keratometry value (K2), mean keratometry value (Km), maximum keratometry value (Kmax), anterior corneal elevation (ACE), and posterior corneal elevation (PCE; P<0.05). The 3rd coma 90°, 4th spherical aberration in back surface and RMS (total), RMS (HOA) in the front, back surfaces, total cornea were positively correlated with K1, K2, Km, Kmax, ACE, and PCE (P<0.05). CONCLUSION: Corneal HOA especially vertical coma and spherical aberration may increase when Vogt’s striae appeared in KCN eyes. The scale of increase is significantly related with changes in corneal shapes.

• Transcapsular scleral fixation of the standard capsular tension ring and in-the-bag intraocular lens implantation for severely subluxated lenses

  Hong-Zhe Li, Fu-Man Yang, Ze-Hui Zhu, Yin-Ying Zhao, Ping-Jun Chang, Yun-E Zhao

  2024,17(12):2321-2326, DOI: 10.18240/ijo.2024.12.22

  Abstract: (4) HTML (0) PDF (1.09 MKB)(8)

  Abstract:

  AIM: To present a technique of transcapsular scleral fixation of the standard capsular tension ring (CTR) through equatorial capsulotomy and in-the-bag intraocular lens (IOL) implantation in subluxated lenses. METHODS: This retrospective consecutive case series included patients with subluxated lenses by more than 180 degrees who underwent lens extraction, transcapsular scleral fixation of the standard CTR through equatorial capsulotomy, in-the-bag IOL implantation and with at least 6mo follow-up. Preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), complications, and postoperative IOL tilt and decentration were recorded. RESULTS: Nine eyes of 7 patients with a mean follow-up of 11.0±3.7mo were included in this study. The BCVA was significantly improved from 0.64±0.22 logMAR preoperatively to 0.21±0.19 logMAR postoperatively (P<0.001). The IOP was within the normal range postoperatively. The mean tilt of the IOL was 4.30°±2.31° (range, 1.0° to 8.9°) and the mean decentration of the IOL was 0.37±0.12 mm (range, 0.14 to 0.50 mm). No visually threatened intraoperative and postoperative complications were detected during the follow-up period. CONCLUSION: This is a safe and effective surgical technique for managing patients with severely subluxated lenses. It has achieved favorable outcomes with fewer surgical manipulations and less need for advanced capsular support devices.

• Thirty-gauge needle-guided purse-string suture pupilloplasty: a new technique

  Chun-Ming Chen, Hong Zhong, Yan Shao, Cheng-Yao Qin, Ze-Hao Liu, Wen-Xiu Sun, Min Li

  2024,17(12):2327-2332, DOI: 10.18240/ijo.2024.12.23

  Abstract: (2) HTML (0) PDF (1.66 MKB)(6)

  Abstract:

  AIM: To observe the clinical outcomes of 30-gauge (G) needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management. METHODS: Eight patients with atonic pupils who underwent suture purse-string pupilloplasty were retrospectively analyzed. Preoperative data and at least 6mo of postoperative data were collected from all the patients. RESULTS: The corrected distance visual acuity (CDVA) before and after surgery was 0.58±0.22 and 0.20±0.10 logMAR, respectively (P=0.002). The pre- and postoperative pupil size was 7.38±0.88 and 3.09±0.71 mm (P=0.000), respectively. The corneal endothelial cell count was 2841±176/mm2 before and 2692±143/mm2 after surgery (P=0.000). No intraoperative or postoperative complications were reported. During the follow-up period of at least 6mo, all treated pupils were centered and generally or nearly round. Furthermore, the patients did not exhibit photophobia, glare, or diplopia. CONCLUSION: This technique is a simple and effective method for pupil reduction.

Letter to the Editor

• Dacryocystitis and canaliculitis secondary to residual of epidural catheter remaining in lacrimal duct for 25 years: a case report and literature review

  Bing-Ran Dong, Ming-Hai Chen, Peng Wang, Hai Tao

  2024,17(12):2333-2335, DOI: 10.18240/ijo.2024.12.24

  Abstract: (9) HTML (0) PDF (729.01 KKB)(10)

  Abstract:

• Bilateral cytomegalovirus retinitis in a patient with dyskeratosis congenita

  Yu-Fei Gao, Ai-Ping Deng, Kang-Wei Jiao, Run Tian

  2024,17(12):2336-2338, DOI: 10.18240/ijo.2024.12.25

  Abstract: (6) HTML (0) PDF (1.20 MKB)(9)

  Abstract:

• Algorithm of automatic identification of diabetic retinopathy foci based on ultra-widefield scanning laser ophthalmoscopy

  Jie Wang, Su-Zhen Wang, Xiao-Lin Qin, Meng Chen, Heng-Ming Zhang, Xin Liu, Meng-Jun Xiang, Jian-Bin Hu, Hai-Yu Huang, Chang-Jun Lan

  Abstract:

  ● AIM: To propose an algorithm for automatic detection of diabetic retinopathy (DR) lesions based on ultra-widefield scanning laser ophthalmoscopy (SLO). ● METHODS: The algorithm utilized the FasterRCNN (Faster Regions with CNN features)+ResNet50 (Residua Network 50)+FPN (Feature Pyramid Networks) method for detecting hemorrhagic spots, cotton wool spots, exudates, and microaneurysms in DR ultra-widefield SLO. Subimage segmentation combined with a deeper residual network FasterRCNN+ResNet50 was employed for feature extraction to enhance intelligent learning rate. Feature fusion was carried out by the feature pyramid network FPN, which significantly improved lesion detection rates in SLO fundus images. ● RESULTS: By analyzing 1076 ultra-widefield SLO images provided by our hospital, with a resolution of 2600×2048 dpi, the accuracy rates for hemorrhagic spots, cotton wool spots, exudates, and microaneurysms were found to be 87.23%, 83.57%, 86.75%, and 54.94%, respectively. ● CONCLUSION: The proposed algorithm demonstrates intelligent detection of DR lesions in ultra-widefield SLO, providing significant advantages over traditional fundus color imaging intelligent diagnosis algorithms.

• The relationship of blood cell-associated inflammatory indices and diabetic retinopathy: a Meta-analysis and systematic review

  Wen-Juan Luo, Wen-Fang Zhang

  Abstract: (64432) HTML (421) PDF (1.51 MKB) (1012)

  Abstract:

  AIM: To explore the correlation between several blood cell-associated inflammatory indices including mean platelet volume (MPV), platelet distribution width (PDW), neutrophil to lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), and the presence and severity of diabetic retinopathy (DR). METHODS: We searched for eligible studies from PubMed, EMBASE, Web of Science and CNKI up to December 13, 2017. Standardized mean difference (SMD) calculated with confidence interval (CI) of 95% was used to estimate the values of those indices. RESULTS: A total of 31 studies were included in the present Meta-analysis. As compared with type 2 diabetes mellitus (T2DM) patients without DR, the values of MPV, PDW, NLR, and PLR were higher in patients with DR (SMD=0.67; 95%CI: 0.36 to 0.98; SMD=0.51; 95%CI: 0.27 to 0.75; SMD=0.77; 95%CI: 0.49 to 1.05 and SMD=1.18; 95%CI: 0.07 to 2.28). Additionally, it was also observed that MPV was closely correlated with the severity of DR. CONCLUSION: MPV, PDW, NLR, and PLR could be recommended as diagnostic biomarkers for DR, and MPV could be applied to assess the severity of DR.

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• Surgical outcome of 21 patients with congenital upper eyelid coloboma

  Arshad Ali Lodhi, Sameen Afzal Junejo, Mahtab Alam Khanzada, Imran Akram Sahaf, Zahid Kamal Siddique

  Abstract: (60182) HTML (0) PDF (420.04 KKB) (1572)

  Abstract:

  AIM: To evaluate the surgical outcome of congenital upper eyelid coloboma repair. · METHODS: All patients underwent complete ophthalmic and general examination before going to surgery, and then examination under anesthesia was performed to assess the site and size of eyelid defect, conjunctival involvement. The status of cornea and ocular motility with forced duction test was also being noted. The surgical procedure was performed according to the size of defect. · RESULTS: Out of 21 cases of congenital upper eyelid coloboma, 18 occurred in isolation with upper eyelid medial defect, 13 were bilateral and 5 were unilateral. Others were associated with Goldenhar syndrome and CHARGE syndrome with bilateral upper lid medial defects. All patients were presented for surgical corrections during age of 2.5-4.0 years except one that presented at 25 years of age. Cosmetically surgical results were acceptable, except one that was already presented with opaque corneal. · CONCLUSION: In this study, overall surgical results were satisfactory except one that was presented late with compromised cornea.

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• Safety of intravitreal quinupristin/dalfopristin in an animal model

  Veronica E. Giordano, Sergio E. Hernandez-Da Mota, Tania N. Adabache-Guel, Armando Castillejos-Chevez, Sonia Corredor-Casas, Samantha M. Salinas-Longoria, Rafael Romero-Vera, Juan M. Jimenez-Sierra, Jose L. Guerrero-Naranjo, Virgilio Morales-Canton

  Abstract: (51002) HTML (421) PDF (594.71 KKB) (880)

  Abstract:

  AIM: To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection. METHODS: Eighteen New Zealand white rabbits were divided into three treatment groups (groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group. The right eye was injected with the drug and the left eye received intravitreal injection of 5% dextrose water and served as control eye. The doses delivered to each group were 0.1 mg/0.1 mL, 1 mg/0.1 mL and 10 mg/0.1 mL. Simultaneous, bilateral, dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection (baseline) and after 7, 14, 21 and 28d, followed by enucleation for histological examination. RESULTS: Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3 (Kruskall-Wallis test, P=0.000). By day 7, no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3, consistent with severe damage due to retinal toxicity. Light microscopy revealed no significant histopathological changes in the group 1, while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases. CONCLUSION: Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with 1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.

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• Ocular manifestation and their associated factors among HIV/AIDS patients receiving highly active antiretroviral therapy in Southern Ethiopia

  Anteneh Amsalu, Kindie Desta, Demiss Nigussie, Demoze Delelegne

  Abstract: (50490) HTML (417) PDF (338.44 KKB) (859)

  Abstract:

  AIM: To assess the pattern of ocular manifestation and associated factors among human immunodeficiency virus (HIV) /acquired immunodeficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART) at Hawassa University Referral Hospital, Southern Ethiopia. METHODS: A cross sectional study was conducted from January 2014 to April 2015. After obtaining informed written consent, 240 adult HIV/AIDS patients on HAART were randomly selected regardless of their ophthalmic symptoms, WHO status or CD4 count. Data were collected using structured questionnaires and ophthalmologic clinical examination. Data were entered and analyzed using SPSS version 20.0 software. RESULTS: The mean duration of HAART was 62.5mo. The prevalence of HIV related ocular manifestation was 14.2%. Seborrheic blepharitis (5%) was the most common ocular manifestation, followed by squamoid conjunctival growth (3.8%). The rate of ocular manifestation was significantly higher among study participants who had CD4+ count <200 cells/μL (AOR=3.83; 95%CI: 1.315-11.153), low duration of HAART (AOR=3.0; 95%CI: 1.305-6.891) and who had primary school education [odds ratio (OR) =2.8; 95%CI: 1.105-7.099]. Prevalence of visual impairment and blindness was 10.9% and 5.8%, respectively. CONCLUSION: HAART may be the reason for the decline in the prevalence of ocular manifestation in HIV/AIDS patients in the study area. Ophthalmologic screening of HIV/AIDS patients, especially those with CD4 counts of <200/μL cells and in the first five years of HAART follow-up is recommended to reduce visual impairment and/or blindness.

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• Research progress about the effect and prevention of blue light on eyes

  Zhi-Chun Zhao, Ying Zhou, Gang Tan, Juan Li

  Abstract: (13463) HTML (453) PDF (290.71 KKB) (2512)

  Abstract:

  In recent years, people have become increasingly attentive to light pollution influences on their eyes. In the visible spectrum, short-wave blue light with wavelength between 415 nm and 455 nm is closely related to eye light damage. This high energy blue light passes through the cornea and lens to the retina causing diseases such as dry eye, cataract, age-related macular degeneration, even stimulating the brain, inhibiting melatonin secretion, and enhancing adrenocortical hormone production, which will destroy the hormonal balance and directly affect sleep quality. Therefore, the effect of Blu-rays on ocular is becoming an important concern for the future. We describe blue light’s effects on eye tissues, summarize the research on eye injury and its physical prevention and medical treatment.

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• Proteomic analysis of anti-angiogenic effects by conbercept in the mice with oxygen induced retinopathy

  Ji Jin, Lei Chen, Gao-Qin Liu, Pei-Rong Lu

  Abstract: (10488) HTML (0) PDF (2.76 MKB) (912)

  Abstract:

  AIM: To analyze the retinal proteomes with and without conbercept treatments in mice with oxygen-induced retinopathy (OIR) and identify proteins involved in the molecular mechanisms mediated by conbercept. METHODS: OIR was induced in fifty-six C57BL/6J mouse pups and randomly divided into four groups. Group 1: Normal17 (n=7), mice without OIR and treated with normal air. Group 2: OIR12/EXP1 (n=14), mice received 75% oxygen from postnatal day (P) 7 to 12. Group 3: OIR17/Control (n=14), mice received 75% oxygen from P7 to P12 and then normal air to P17. Group 4: Lang17/EXP2 (n=21), mice received 75% oxygen from P7 to P12 with intravitreal injection of 1 μL conbercept at the concentration of 10 mg/mL at P12, and then normal air from P12 to P17. Liquid Chromatography-Mass Spectrometry (LC-MS)/MS data were reviewed to find proteins that were up-regulated after the conbercept treatment. Gene ontology (GO) analysis was performed of conbercept-mediated changes in proteins involved in single-organism processes, biological regulation, cellular processes, immune responses, metabolic processes, locomotion and multiple-organism processes. RESULTS: Conbercept induced a reversal of hypoxia-inducible factor 1 signaling pathway as revealed by the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis and also induced down-regulation of proteins involved in blood coagulation and fibrin clot formation as demonstrated by the Database for Annotation, Visualization and Integrated Discovery (DAVID) and the stimulation of interferon genes studies. These appear to be risk factors of retinal fibrosis. Additional conbercept-specific fibrosis risk factors were also identified and may serve as therapeutic targets for fibrosis. CONCLUSION: Our studies reveal that many novel proteins are differentially regulated by conbercept. The new insights may warrant a valuable resource for conbercept treatment.

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• Achromatopsia caused by novel missense mutations in the CNGA3 gene

  Xi-Teng Chen, Hui Huang, Yan-Hua Chen, Li-Jie Dong, Xiao-Rong Li, Xiao-Min Zhang

  Abstract: (9480) HTML (0) PDF (771.47 KKB) (938)

  Abstract:

  AIM:To identify the genetic defects in a Chinese family with achromatopsia.METHODS:A 2.5-year-old boy, who displayed nystagmus, photophobia, and hyperopia since early infancy, was clinically evaluated. To further confirm and localize the causative mutations in this family, targeted region capture and next-generation sequencing of candidate genes, such as CNGA3, CNGB3, GNAT2, PDE6C, and PDE6H were performed using a custom-made capture array.RESULTS:Slit-lamp examination showed no specific findings in the anterior segments. The optic discs and maculae were normal on fundoscopy. The unaffected family members reported no ocular complaints. Clinical signs and symptoms were consistent with a clinical impression of autosomal recessive achromatopsia. The results of sequence analysis revealed two novel missense mutations in CNGA3, c.633T>A (p.D211E) and c.1006G>T (p.V336F), with an autosomal recessive mode of inheritance.CONCLUSION: Genetic analysis of a Chinese family confirmed the clinical diagnosis of achromatopsia. Two novel mutations were identified in CNGA3, which extended the mutation spectrum of this disorder.

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• Tests for malingering in ophthalmology

  Ali Ihsan Incesu

  Abstract: (9135) HTML (0) PDF (281.98 KKB) (1417)

  Abstract:

  Simulation can be defined as malingering, or sometimes functional visual loss (FVL). It manifests as either simulating an ophthalmic disease (positive simulation), or denial of ophthalmic disease (negative simulation). Conscious behavior and compensation or indemnity claims are prominent features of simulation. Since some authors suggest that this is a manifestation of underlying psychopathology, even conversion is included in this context. In today’s world, every ophthalmologist can face with simulation of ophthalmic disease or disorder. In case of simulation suspect, the physician’s responsibility is to prove the simulation considering the disease/disorder first, and simulation as an exclusion. In simulation examinations, the physician should be firm and smart to select appropriate test(s) to convince not only the subject, but also the judge in case of indemnity or compensation trials. Almost all ophthalmic sensory and motor functions including visual acuity, visual field, color vision and night vision can be the subject of simulation. Examiner must be skillful in selecting the most appropriate test. Apart from those in the literature, we included all kinds of simulation in ophthalmology. In addition, simulation examination techniques, such as, use of optical coherence tomography, frequency doubling perimetry (FDP), and modified polarization tests were also included. In this review, we made a thorough literature search, and added our experiences to give the readers up-to-date information on malingering or simulation in ophthalmology.

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• Therapeutic effects of mesenchymal stem cells administered at later phase of recurrent experimental autoimmune uveitis

  Ping-Ting Zhao, Ling-Jun Zhang, Hui Shao, Ling-Ling Bai, Bo Yu, Chang Su, Li-Jie Dong, Xun Liu, Xiao-Rong Li, Xiao-Min Zhang

  Abstract: (8764) HTML (0) PDF (2.01 MKB) (834)

  Abstract:

  AIM: To test the therapeutic effects of delayed treatment of mesenchymal stem cells (MSCs) in recurrent experimental autoimmune uveitis (rEAU). METHODS: The efficacy of different regimens of MSC administration in rEAU were tested by evaluation of clinical and pathological intraocular inflammation, as well as retinal structural and functional integrity using optical coherence tomography (OCT) and electroretinogram (ERG). The retinal sections were also immunostained with antibodies to glial fibrillary acidic protein (GFAP) and rhodopsin (RHO). RESULTS: Delayed treatment of MSCs effectively alleviated the severity of intraocular inflammation with relative intact of outer retinal structure and function. Moreover, double therapies with longer interval led to an even better clinical evaluation, as well as a trend of decrease in relapse and amelioration of retinal function. MSC therapies also effectively reduced GFAP expression and increased RHO expression in the retina. CONCLUSION: MSC administration can effectively treat developed diseases of rEAU, and multiple therapies can provide additional therapeutic benefits.

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• Rapamycin ameliorates experimental autoimmune uveoretinitis by inhibiting Th1/Th2/Th17 cells and upregulating CD4+CD25+ Foxp3 regulatory T cells

  Li-Fei Yuan, Guang-Da Li, Xin-Jun Ren, Hong Nian, Xiao-Rong Li, Xiao-Min Zhang

  Abstract: (8003) HTML (0) PDF (871.51 KKB) (831)

  Abstract:

  AIM:To determine the effects of rapamycin on experimental autoimmune uveoretinitis (EAU) and investigate of role of rapamycin on T cell subsets in the disease. METHODS:EAU was induced in rats using peptides 1169 to 1191 of the interphotoreceptor binding protein (IRBP). Rapamycin (0.2 mg/kg/d) was administrated by intraperitoneal injection for a consecutive 7d after immunization. Th1/Th2/Th17 cytokines, TGF-β1, and IL-6 produced by lymphocyteswere measured by ELISA, while Th17 cells and CD4+CD25+ regulatory T cells (Tregs) from rat spleen were detected by flow cytometry. RESULTS: Intraperitoneal treatment immediately after immunization dramatically ameliorated the clinical course of EAU. Clinical responses were associated with reduced retinal inflammatory cell infiltration and tissue destruction. Rapamycin induced suppression of Th1/Th2/Th17 cytokines, including IFN-γ, IL-2, IL-17, IL-4, and IL-10 release from T lymphocytes of EAU rats, in vitro. Rapamycin also significantly increased TGF-β1 production but had no effect on IL-6 productionof T lymphocytes from EAU rats in vitro. Furthermore, rapamycin decreased the ratio of Th17 cells/CD4+T cells and upregulated Tregs in EAU, as detected by flow cytometry. CONCLUSION: Rapamycin effectively interferes with T cell mediated autoimmune uveitis by inhibiting antigen-specific T cell functions and enhancing Tregs in EAU. Rapamycin is a promising new alternative as an adjunct corticosteroid-sparing agent for treating uveitis.

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• Superglue injuries of the eye

  Sagili Chandrasekhara Reddy

  Abstract: (7824) HTML (0) PDF (669.75 KKB) (1528)

  Abstract:

  AIM: To report various ocular lesions caused by accidental instillation of superglue.METHODS: Three cases of ocular injuries are described in children aged 6 years, 3 years and 8 months, following accidental instillation of superglue in the eye.RESULTS: In the first case there was sticking of eyelashes in the medial 1/3 of eyelids in both eyes. In the second case sticking of eye lashes was present in the lateral 1/3 of eyelids in the left eye. In the third case, superglue was present on the right cheek, above the right ear and sticking of eyelids in medial 1/3 in right eye. The eyelids were separated by pulling the lid margins with fingers in the first case and later on superglue was removed by trimming the eyelashes; and by direct trimming the eyelashes in second and third cases. There was no injury to other structures of anterior segment in the first two cases. However, removal of the superglue on the cornea resulted in corneal abrasion in the third case which healed with medical treatment and patching of the right eye.CONCLUSION: Accidental instillation of superglue is possible because of the appearance of the tube like eye ointment tube. Immediate medical aid will prevent ocular morbidity.

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• A near-vision chart for children aged 3-5 years old:new designs and clinical applications

  Yang-Qing Huang, He Huang, Rong-Zhi Huang

  Abstract: (6829) HTML (0) PDF (963.79 KKB) (1065)

  Abstract:

  AIM:To introduce a new near-vision chart for children aged 3-5 years old and its clinical applications.METHODS:The new near-vision chart which combined the Bailey-Lovie layout with a newly devised set of symmetry symbols was designed based on Weber-Fechner law. It consists of 15 rows of symmetry symbols, corresponding to a visual acuity range from 1.3 to 0.1 logMAR. The optotypes were red against a white background and were specially shaped four basic geometric symbols:circle, square, triangle，and cross, which matched the preschool children''s cognitive level. A regular geometric progression of the optotype sizes and distribution was employed to arrange in 15 lines. The progression rate of the optotype size between two lines was 1.2589 and two smaller groups of optotypes ranging from 0.7 to -0.1 logMAR were included for repetitive testing. A near visual acuity was recorded in logMAR or decimal, and the testing distance was 25 cm.RESULTS:This new near-vision chart with pediatric acuity test optotypes which consists of 4 different symbols (triangle, square, cross, and circle) met the national and international eye chart design guidelines. When performing the near visual acuity assessment in preschoolers (3-5 years old). It overcame an inability to recognize the letters of the alphabet and difficulties in designating the direction of black abstract symbols such as the tumbling ''E'' or Landolt ''C'', which the subjects were prone to lose interest in. Near vision may be recorded in different notations:decimal acuity and logMAR. These two notations can be easily converted each other in the new near-vision chart. The measurements of this new chart not only showed a significant correlation and a good consistency with the Chinese national standard logarithmic near-vision chart (r=0.932, P<0.01), but also indicated good test-retest reliability (89% of retest scores were within 0.1 logMAR units of the initial test score) and a high response rate.CONCLUSION:The results of this study support the validity and reliability of near visual acuity measurements using the new near-vision chart in children aged 3-5y over a wide range of visual acuities, and the new eye chart was especially suitable for the detection of amblyopia risk factors and low vision examination in children (3-5y of age). It can be applied in routine clinical practice.

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• Malingering or simulation in ophthalmology-visual acuity

  Ali Ihsan Incesu, Güng?r Sobac?

  Abstract: (6416) HTML (0) PDF (320.40 KKB) (1332)

  Abstract:

  Simulation can be defined as malingering, or sometimes functional visual loss (FVL). It manifests as either simulating an ophthalmic disease (positive simulation), or denial of ophthalmic disease (negative simulation). Conscious behavior and compensation or indemnity claims are prominent features of simulation. Since some authors suggest that this is a manifestation of underlying psychopathology, even conversion is included in this context. In today's world, every ophthalmologist can face with simulation of ophthalmic disease or disorder. In case of simulation suspect, the physician's responsibility is to prove the simulation considering the disease/disorder first, and simulation as an exclusion. In simulation examinations, the physician should be firm and smart to select appropriate test(s) to convince not only the subject, but also the judge in case of indemnity or compensation trials. Almost all ophthalmic sensory and motor functions including visual acuity, visual field, color vision and night vision can be the subject of simulation. Examiner must be skillful in selecting the most appropriate test. Apart from those in the literature, we included all kinds of simulation in ophthalmology. In addition, simulation examination techniques, such as, use of OCT (optical coherence tomography), frequency doubling perimetry (FDP), and modified polarization tests were also included. In this review, we made a thorough literature search, and added our experiences to give the readers up-to-date information on malingering or simulation in ophthalmology.

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• Comparison of fibrin glue and suture technique in pterygium surgery performed with limbal autograft

  Bora Yüksel, Sultan Kaya ünsal, Sevgi Onat

  Abstract: (6210) HTML (0) PDF (165.03 KKB) (1410)

  Abstract:

  AIM: To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft. METHODS: A prospective randomised clinical trial was carried out in 58 eyes of 58 patients operated for primary nasal pterygium. Autologous conjunctival graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision. In 29 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive (Beriplast P) and in 29 eyes with 8-0 Virgin silk sutures. The Mann-Whitney U test was used for statistical analysis. Postoperative patient discomfort (pain, stinging, watering) and biomicroscopic findings (hyperemia, edema) were graded. Patients were followed up at least for six months. RESULTS: Subconjunctival hemorrhage occured under the graft in one patient in group 1. In seven cases of group 2, sutures were removed at the 15th day because of granulomatous tissue reaction. Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in one case of group 1, and 2 cases of group 2. Average surgery cost was higher (P<0.05) and surgery time was shorter (P<0.05) in fibrin group. CONCLUSION: Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.

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• Prevalence of vitreous floaters in a community sample of smartphone users

  Blake F. Webb, Jadon R. Webb, Mary C. Schroeder, Carol S. North

  Abstract: (6196) HTML (0) PDF (202.26 KKB) (1235)

  Abstract:

  AIM: To estimate the prevalence and risk factors for vitreous floaters in the general population.METHODS: An electronic survey was administered through a smartphone app asking various demographic and health questions, including whether users experience floaters in their field of vision. Multivariate logistic regression analysis was used to determine risk factors.RESULTS:A total of 603 individuals completed the survey, with 76% reporting that they see floaters, and 33% reporting that floaters caused noticeable impairment in vision. Myopes were 3.5 times more likely (P=0.0004), and hyperopes 4.4 times more likely (P=0.0069) to report moderate to severe floaters compared to those with normal vision. Floater prevalence was not significantly affected by respondent age, race, gender, and eye color.CONCLUSION:Vitreous floaters were found to be a very common phenomenon in this non-clinical general population sample, and more likely to be impairing in myopes and hyperopes.

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• Photobiomodulation for the treatment of retinal diseases: a review

  Ivayla I. Geneva

  Abstract: (6067) HTML (0) PDF (331.95 KKB) (1210)

  Abstract:

  Photobiomodulation (PBM), also known as low level laser therapy, has recently risen to the attention of the ophthalmology community as a promising new approach to treat a variety of retinal conditions including age-related macular degeneration, retinopathy of prematurity, diabetic retinopathy, Leber’s hereditary optic neuropathy, amblyopia, methanol-induced retinal damage, and possibly others. This review evaluates the existing research pertaining to PBM applications in the retina, with a focus on the mechanisms of action and clinical outcomes. All available literature until April 2015 was reviewed using PubMed and the following keywords: “photobiomodulation AND retina”, “low level light therapy AND retina”, “low level laser therapy AND retina”, and “FR/NIR therapy AND retina”. In addition, the relevant references listed within the papers identified through PubMed were incorporated. The literature supports the conclusion that the low-cost and non-invasive nature of PBM, coupled with the first promising clinical reports and the numerous preclinical-studies in animal models, make PBM well-poised to become an important player in the treatment of a wide range of retinal disorders. Nevertheless, large-scale clinical trials will be necessary to establish the PBM therapeutic ranges for the various retinal diseases, as well as to gain a deeper understanding of its mechanisms of action.

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• Cod liver oil: a potential protective supplement for human glaucoma

  Wen-Bin Huang, Qian Fan, Xiu-Lan Zhang

  Abstract: (6013) HTML (0) PDF (246.01 KKB) (1246)

  Abstract:

  Glaucoma is one of the leading causes of visual impairment and blindness. Improved knowledge of the pathogenesis of this disease has allowed the exploration of new therapeutic methods. In general, elevated intraocular pressure (IOP), oxidative stress, and vascular insufficiency are accepted as the major risk factors for the progression of glaucoma. Many natural compounds have been found beneficial for glaucoma. Nutritional therapies are now emerging as potentially effective in glaucomatous therapy. One nutritional supplement with potential therapeutic value is cod liver oil, a dietary supplement that contains vitamin A and omega-3 polyunsaturated fatty acids (PUFAs). Vitamin A is important for preserving normal vision and it is a well-known antioxidant that prevents the oxidative damage that contributes to the etiology and progression of glaucoma. Vitamin A is also a crucial factor for maintaining the integrity of conjunctival and corneal ocular surfaces, and preventing the impairment of ocular epithelium caused by topical antiglaucomatous drugs. Omega-3 fatty acids are beneficial for glaucoma patients as they decrease IOP, increase ocular blood flow, and improve optic neuroprotective function. In this article, we propose that cod liver oil, as a combination of vitamin A and omega-3 fatty acids, should be beneficial for the treatment of glaucoma. However, further studies are needed to explore the relationship between cod liver oil and glaucoma.

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• Epidemiology and molecular genetics of congenital cataracts

  Jun Yi, Jun Yun, Zhi-Kui Li, Chang-Tai Xu, Bo-Rong Pan

  Abstract: (6006) HTML (0) PDF (570.98 KKB) (1573)

  Abstract:

  · Congenital cataract is a crystallin severe blinding disease and genetic factors in disease development are important. Crystallin growth is under a combination of genes and their products in time and space to complete the coordination role of the guidance. Congenital cataract-related genes, included crystallin protein gene (CRYAA, CRYAB, CRYBA1/A3, CRYBA4, CRYBB1, CRYBB2, CRYBB3, CRYGC, CRYGD, CRYGS), gap junction channel protein gene (GJA1, GJA3, GJA8), membrane protein gene (GJA3, GJA8, MIP, LIM2), cytoskeletal protein gene (BF-SP2), transcription factor genes (HSF4, MAF, PITX3, PAX6), ferritin light chain gene (FTL), fibroblast growth factor (FGF) and so on. Currently, there are about 39 genetic loci isolated to which primary cataracts have been mapped, although the number is constantly increasing and depends to some extent on definition. We summarized the recent advances on epidemiology and genetic locations of congenital cataract in this review.

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• Aniridia rings implantation for treatment of congenital aniridia combined with cataract surgery: a case report

  Juan-Juan Li, Yun-Peng Li, Zhu-Lin Hu

  Abstract: (5791) HTML (0) PDF (87.46 KKB) (1361)

  Abstract:

  We describe the successful treatment in a patient with bilateral congenital aniridia and cataract by insertion of capsular tension rings and IOL.

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• Prevention of exposure keratopathy in intensive care unit

  Hua Shan, Du Min

  Abstract: (5724) HTML (0) PDF (107.88 KKB) (1282)

  Abstract:

  AIM: To compare the efficacy for preventing exposure keratopathy of three forms of eye care (artificial tear, moist chamber and polyethylene covers) for intensive care patients. METHODS: Eighty-four patients in Intensive Care Unit (ICU) were randomized to three treatment groups, including artificial tears group, moist chambers group and polyethylene film group. Patients of artificial tear group received two drops of carboxymethylcellulose drops to each eye every 2 hours. The moist chambers and the polyethylene were changed every 12 hours or as needed if they became unclean or torn. The corneal fluorescein stains were performed daily. RESULTS: No of 28 patients (0%) in the polyethylene group and one of the 27 patients (3.70%) in the moist chamber group had exposure keratopathy, compared to 8 of the 29 patients (27.59%) in the artificial tear group. There were statistical significance between the artificial tear group and the moist chamber group (P=0.02), and the artificial tear group and the polyethylene group (P =0.003). The time on eye care every day of the artificial tear group, the moist chamber group and the polyethylene group was 26.69±2.39 minutes, 35.33±2.63 minutes and 7.48±0.87 minutes, respectively. The eye care of the polyethylene group were statistically more time-save than that of the artificial tear group (P<0.001) and the moist chamber group (P<0.001). CONCLUSION: Polyethylene covers are more effective and more time-saving in reducing the incidence of corneal damage in intensive care patients

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