Volume 9,Issue 10,2016 Table of Contents

1 The role of Dectin-1/Raf-1 signal cascade in innate immune of human corneal epithelial cells against Aspergillus fumigatus infection

Gui-Qiu Zhao , Jing Lin , Li-Ting Hu , Xiao-Ni Yin , Qian Wang , Qiang Xu , Hui Li

2016, 9(10):1371-1375. DOI: 10.18240/ijo.2016.10.01

[Abstract](1723) [HTML](0) [PDF 688.68 K](706)

Abstract:
AIM: To investigate the expression of the v-raf-1 murine leukemia viral oncogene homolog 1 (Raf-1) and its role in the innate immune response of human corneal epithelial cells (HCECs) infected by Aspergillus fumigatus. METHODS: HCECs were cultured in vitro. They were randomly divided into 4 groups, including control group, Aspergillus fumigatus group, GW5074 (an inhibitor of Raf-1) group and Laminarin [an inhibitor of Dendriti-cell-associated C-type lectin 1 (Dectin-1)] group. The protein expression level of total Raf-1 and p-Raf-1was measured by Western blot. The expression of IL-6 and IL-8 mRNA in each group was detected by real-time polymerase chain reaction. RESULTS: In Aspergillus fumigatus group, total Raf-1 protein levels in HCECs remained unchanged at 5, 15, 30 and 45min after infection, while p-Raf-1 expression was significantly enhanced at 30min after infection compared with control group. However, the expression of p-Raf-1 was apparently declined after treated with GW5074 or Laminarin compared with Aspergillus fumigatus group. The expression levels of IL-6, IL-8 mRNA were significantly increased after stimulation with fumigatus compared with control group. Pre-treated with GW5074 significantly inhibited Aspergillus fumigatus-induced upregulation of IL-8 and IL-6. CONCLUSION: Aspergillus fumigatus stimulation can elevate the expression of p-Raf-1 in HCECs in vitro. Dectin-1/Raf-1 signal pathway may play a role on regulating the expression of inflammatory cytokines, including IL-6 and IL-8.

2 Effects of dexamethasone and HA1077 on actin cytoskeleton and β-catenin in cultured human trabecular meshwork cells

Jie Peng , Xiao-Yun Feng , Zi-Meng Ye , Qian Luo , Yi-Lian Cheng , Zheng-Zheng Wu , Chun-Tao Lei , Bo Gong

2016, 9(10):1376-1380. DOI: 10.18240/ijo.2016.10.02

[Abstract](1459) [HTML](0) [PDF 665.06 K](665)

Abstract:
AIM: To investigate the effects of dexamethasone (DEX) and 1-(5-isoquinolinesulfonyl)-homopiperazine (HA1077) on actin cytoskeleton and β-catenin in cultured human trabecular meshwork (HTM) cells. METHODS: The HTM cells were separated from human eyeball and cultured in vitro. They were divided into control group, DEX (1×10-6 mol/L) group, HA1077 (3×10-5 mol/L) group, and DEX (1×10-6 mol/L) and HA1077 (3×10-5 mol/L) group. Actin cytoskeleton and β-catenin in HTM cells of the four groups were examined by immunofluorescence and Western blot analyses. RESULTS: In DEX group, there were reorganization of actin cytoskeleton and formation of cross linked actin networks (CLANs), which were partially reversed in DEX and HA1077 group. DEX treatment also induced an increased expression of β-catenin, which was obviously reduced in DEX and HA1077 group. Meanwhile, the cultured HTM cells in HA1077 group had lower expression of β-catenin than that in the control group. CONCLUSION: Our results show that HA1077 can reverse the changes of actin organization and expression of β-catenin induced by DEX in cultured HTM cells, suggesting that HA1077 may play an important role in increasing outflow and reducing intraocular pressure.

3 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

2016, 9(10):1381-1389. DOI: 10.18240/ijo.2016.10.03

[Abstract](8767) [HTML](0) [PDF 2.01 M](865)

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.

4 Gene expression and histopathological evaluation of thiamine pyrophosphate on optic neuropathy induced with ethambutol in rats

Emine Cinici , Nihal Cetin , Bahadir Suleyman , Durdu Altuner , Oguzhan Yarali , Hilal Balta , Ilknur Calik , Levent Tumkaya , Halis Suleyman

2016, 9(10):1390-1395. DOI: 10.18240/ijo.2016.10.04

[Abstract](1421) [HTML](0) [PDF 693.23 K](837)

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AIM: To compare the effects of thiamine pyrophosphate (TPP) and thiamine (TM) in oxidative optic neuropathy in rats induced by ethambutol. METHODS: The animals were divided into four groups: a control group (CG), an ethambutol control (ETC) group, TM plus ethambutol group (TMG), and TPP plus ethambutol group (TPPG). One hour after intraperitoneal administration of TM 20 mg/kg to the TMG group and TPP 20 mg/kg to TPPG group, 30 mg/kg ethambutol was given via gavage to all the groups but the CG. This procedure was repeated once daily for 90d. After that period, all rats were exposed to high levels of anaesthesia in order to investigate the gene expression of malondialdehyde and glutathione in removed optic nerve tissue and histopathologically to examine these tissues. RESULTS: Malondialdehyde gene expression significantly increased, whereas glutathione gene expression significantly decreased in the ETC group compared to the CG. TM could not prevent the increase of malondialdehyde gene expression and the decrease of glutathione, while TPP significantly could suppress. Histopathologically, significant vacuolization in the optic nerve, single-cell necrosis in the glial cells, and a decrease in oligodendrocytes were observed in the ETC group. Vacuolization in the optic nerve, a decrease in oligodendrocytes and single-cell necrosis were found in the TMG group, while no pathological finding was observed in the TPPG group except for mild vacuolization. CONCLUSION: TPP protects the optic nerve against the ethambutol-induced toxicity but TM does not. TPP can be beneficial in prophilaxis of optic neuropathy in ethambutol therapy.

5 Novel TRPM1 mutations in two Chinese families with early-onset high myopia, with or without complete congenital stationary night blindness

Lin Zhou , Tuo Li , Yi-Qiao Xing , Yin Li , Qing-Song Wu , Mao-Ju Zhang

2016, 9(10):1396-1402. DOI: 10.18240/ijo.2016.10.05

[Abstract](1505) [HTML](0) [PDF 923.36 K](747)

Abstract:
AIM: To investigate the relationship between high myopia [with or without complete congenital stationary night blindness (CSNB1)] and TRPM1 and NYX. METHODS: Two unrelated families with early-onset high myopia (eoHM) and 96 normal controls were recruited. Sanger sequencing or clone sequencing were used for mutation screening. Further analyses of the available family members and the 96 normal controls were subsequently conducted to obtain additional evidence of the pathogenicity of these variants. The initial diagnosis of the probands was eoHM. We performed a further comprehensive examination of the available family members after mutations were detected in TRPM1 or NYX. RESULTS: Two novel compound heterozygous mutations in TRPM1 were detected in the recruited families. The proband in family A with eoHM carried a c.2594C>T missense mutation in exon 19 and a c.669+3_669+6delAAGT splicing mutation, which was co-segregated with CSNB1 in this family. A patient in family B with a compound heterozygous missense mutation (c.3262G>A and c.3250T>C) was detected. No mutations were found in NYX. These two identified compound heterozygous mutations were not found in the 96 normal controls. After further examination of the family members, the patients in family A could be diagnosed as eoHM with CSNB1. However due to the limited clinic data, the patient in family B cloud not clearly diagnosed as CSNB1. CONCLUSION: This study has expanded the mutation spectrum of TRPM1 for CSNB1 and additional studies are needed to elucidate the association between isolated high myopia and TRPM1 and NYX.

6 FGFR2 mutation in a Chinese family with unusual Crouzon syndrome

Zi-Li Li , Xue Chen , Wen-Juan Zhuang , Wei Zhao , Ya-Ni Liu , Fang-Xia Zhang , Ruo-Shui Ha , Jin-Hua Wu , Chen Zhao , Xun-Lun Sheng

2016, 9(10):1403-1408. DOI: 10.18240/ijo.2016.10.06

[Abstract](1993) [HTML](0) [PDF 895.56 K](736)

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AIM: To describe the clinical characteristics with genetic lesions in a Chinese family with Crouzon syndrome. METHODS: All five patients from this family were included and received comprehensive ophthalmic and systemic examinations. Direct sequencing of the FGFR2 gene was employed for mutation identification. Crystal structure analysis was applied to analyze the structural changes associated with the substitution. RESULTS: All patients presented typical Crouzon features, including short stature, craniosynostosis, mandibular prognathism, shallow orbits with proptosis, and exotropia. Intrafamilial phenotypic diversities were observed. Atrophic optic nerves were exclusively detected in the proband and her son. Cranial magnetic resonance imaging (MRI) implied a cystic lesion in her sellar and third ventricular regions. A missense mutation, FGFR2 p.Cys342Trp, was found as disease causative. This substitution would generate conformational changes in the extracellular Ig-III domain of the FGFR-2 protein, thus altering its physical and biological properties. CONCLUSION: We describe the clinical presentations and genotypic lesions in a Chinese family with Crouzon syndrome. The intrafamilial phenotypic varieties in this family suggest that other genetic modifiers may also play a role in the pathogenesis of Crouzon syndrome.

7 Effect of femtosecond and microkeratome flaps creation on the cornea biomechanics during laser in situ keratomileusis: one year follow-up

Qian Sun , Zheng-Zheng Deng , Yue-Hua Zhou , Jing Zhang , Xiao-Yan Peng

2016, 9(10):1409-1414. DOI: 10.18240/ijo.2016.10.07

[Abstract](2914) [HTML](0) [PDF 335.52 K](664)

Abstract:
AIM: To compare the corneal biomechanical outcomes at one year after laser in situ keratomileusis (LASIK) with the flaps created by Ziemer and Moria M2 microkeratome with 110 head and -20 blade. METHODS: Totally 100 eyes of 50 consecutive patients were enrolled in this prospective study and divided into two groups for corneal flaps created by ZiemerFemto LDV and Moria M2 microkeratome with 110 head and -20 blade. Corneal biomechanical properties including cornea resistance factor (CRF) and cornea hysteresis (CH) were measured before and 1, 3, 6, 12mo after surgery by ocular response analyzer. Central cornea thickness and corneal flap thickness were measured by optical coherence tomography. RESULTS: The ablation depth (P=0.693), residual corneal thickness (P=0.453), and postoperative corneal curvature (P=0.264) were not significant different between Ziemer group and Moria 110-20 group after surgery. The residual stromal bed thickness, corneal flap thickness, CH and CRF at 12mo after surgery were significant different between Ziemer group and Moria 110-20 group (P<0.01);Ziemer group gained better corneal biomechanical results. The CRF and CH increased gradually from 1 to 12mo after surgery in Ziemer group, increased from 1 to 6mo but decreased from 6 to 12mo in Moria 110-20 group. Both CRF and CH at one year after surgery increased with the increasing of residual cornea thickness; pre-LASIK CRF, CRF also increased with residual stromal bed thickness, while CH decreased with the increasing of pre-LASIK intraocular pressure and cornea flap thickness (P<0.01). CONCLUSION: In one year follow-up, femtosecond laser can provide better cornea flaps with stable cornea biomechanics than mechanical microkeratome.

8 Trabeculectomy with Ex-PRESS implant versus Ahmed glaucoma valve implantation-a comparative study

Michael Waisbourd , Naomi Fischer , Hadas Shalev , Oriel Spierer , Elad Ben Artsi , Rony Rachmiel , Gabi Shemesh , Shimon Kurtz

2016, 9(10):1415-1420. DOI: 10.18240/ijo.2016.10.08

[Abstract](1190) [HTML](0) [PDF 291.85 K](616)

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AIM: To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve (AGV) implantation. METHODS: Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review. Main outcome measures were surgical failure and complications. Failure was defined as intraocular pressure (IOP) >21 mm Hg or <5 mm Hg on two consecutive visits after 3mo, reoperation for glaucoma, or loss of light perception. Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy. RESULTS: A total of 64 eyes from 57 patients were included: 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group. The mean follow-up time was 2.6±1.1y and 3.3±1.6y, respectively. Patients in the AGV group had significantly higher baseline mean IOP (P=0.005), lower baseline mean visual acuity (VA) (P=0.02), and higher proportion of patients with history of previous trabeculectomy (P<0.0001). Crude failure rates were 16.1%, n=5/31 in the Ex-PRESS group and 24.2%, n=8/33 in the AGV group. The cumulative proportion of failure was similar between the groups, P=0.696. The proportion of eyes that experienced postoperative complications was 32.3% in the Ex-PRESS group and 60.1% in the AGV group (P=0.0229). CONCLUSION: Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates. The AGV group had more post-operative complications, but also included more complex cases with higher baseline mean IOP, worse baseline mean VA, and more previous glaucoma surgeries. Therefore, the results are limited to the cohort included in this study.

9 Implantable collamer lens for residual refractive error after corneal refractive surgery

Xun Chen , Xiao-Ying Wang , Xi Zhang , Zhi Chen , Xing-Tao Zhou

2016, 9(10):1421-1426. DOI: 10.18240/ijo.2016.10.09

[Abstract](1708) [HTML](0) [PDF 587.06 K](815)

Abstract:
AIM: To assess the safety, efficacy, predictability and stability of implantable collamer lens (ICL) for residual refractive error after corneal refractive surgery. METHODS: This study evaluated 19 eyes of 12 patients who underwent ICL implantation after corneal refractive surgeries. They were followed up for 1y to 5y of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractive error, flat and steep K value, axial length, intraocular pressure, corneal endothelial cell density, adverse events after ICL surgery. RESULTS: The mean follow-up period was 39.05±19.22 mo (range, 1-5y). Spherical equivalent refractive error changed from -7.45±3.02 D preoperatively to -0.85±1.10 D 1wk to 1mo after ICL implantation, with the safety and efficacy indices being 1.12 and 1.15, respectively. A total of 52.63% of eyes were within ±0.5 D of the predicted spherical equivalents, 73.68% were within ±1.0 D. A trend of mild regression towards myopia with axial elongation after 5y was observed. One eye with mild anterior capsule opacity and retinal detachment 1y after surgery were observed. CONCLUSION: ICL implantation is safe and effective for the correction of residual refractive error after corneal refractive surgeries, especially in moderate to high residual myopia.

10 An eighteen-month follow-up study on the effects of Intravitreal Dexamethasone Implant in diabetic macular edema refractory to anti-VEGF therapy

Fernanda Pacella , Maria Rosaria Romano , Paolo Turchetti , Giovanna Tarquini , Anna Carnovale , Antonella Mollicone , Alessandra Mastromatteo , Elena Pacella

2016, 9(10):1427-1432. DOI: 10.18240/ijo.2016.10.10

[Abstract](2593) [HTML](0) [PDF 398.21 K](718)

Abstract:
AIM: To evaluate the long-term efficacy and safety of dexamethasone implants in subjects affected by diabetic macular edema (DME) resistant to anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Thirty-two DME patients were enrolled. A 700 microgram slow release Intravitreal Dexamethasone Implant (Ozurdex®) was placed in the vitreous cavity. All patients were followed for 18mo. Best-corrected visual acuity (BCVA) measured with Early Treatment Diabetic Retinopathy Study (ETDRS) and central macular thickness (CMT) exams were carried out at baseline (T0) and after 1 (T1), 3 (T3), 4 (T4), 6 (T6), 9 (T9), 12 (T12), 15 (T15), and 18mo (T18) post injection. RESULTS: Repeated measures ANOVA showed an effect of treatment on ETDRS (P<0.0001). Post hoc analyses revealed that ETDRS values were significantly increased at T1, T3, T4, T9, and T15 (P<0.001) as compared to baseline value (T0). At T6, T12, and T18, ETDRS values were still statistically higher than baseline (P<0.001 vs T0). However, at these time points, we observed a trend to return to baseline conditions. ANOVA also showed an effect of treatment (P<0.0001). CMT decreased significantly at T1, T3, T4, T9, and T15 (P<0.001). At T6 (P<0.01), T12 and T18 (P<0.001) CMT was also significantly lower than T0 although a trend to return to the baseline conditions was also observed. CONCLUSION: Our findings demonstrate that Intravitreal Dexamethasone Implant is a good option to improve BCVA and CMT in DME patients resistant to anti-VEGF therapy. Our data also show that the use of drugs administered directly into the vitreous allows achieving appropriate and long-lasting concentration at the site of disease without systemic side effects.

11 Association of macular pigment optical density with early stage of non-proliferative diabetic retinopathy in Chinese patients with type 2 diabetes mellitus

Chong-Yang She , Hong Gu , Jun Xu , Xiu-Fen Yang , Xue-Tao Ren , Ning-Pu Liu

2016, 9(10):1433-1428. DOI: 10.18240/ijo.2016.10.11

[Abstract](1747) [HTML](0) [PDF 302.76 K](540)

Abstract:
AIM: To detect the association between macular pigment optical density (MPOD), which reflects the antioxidant ability of retina, and diabetic retinopathy (DR) and to investigate the correlated factors of MPOD. METHODS: Totally 435 subjects of urban Chinese were recruited to the study and divided into 3 groups: non-diabetes mellitus controls (NDM), diabetic patients without retinopathy (DWR), and patients with early stage of non-proliferative diabetic retinopathy (DR). Demographic and lifestyle characteristics were ascertained by questionnaire. A food-frequency questionnaire, general physical and ophthalmic examinations were completed for all participants. MPOD was measured by heterochromatic flicker photometry. Foveal thickness was measured by optical coherence tomography. The difference of MPOD among 3 groups was analyzed by analysis of covariance. The correlation analyses of MPOD with the candidate influence factors were assessed using the generalized estimating equations (GEE) model. RESULTS: Of the 435 participants, 34 could not perform the MPOD measurements. Final analysis included 401 subjects, including 48 were in DR group, 134 in DWR group, and 219 in NDM group. MPOD was not significantly different among DR (0.49±0.21), DWR (0.45±0.21), and NDM (0.49±0.17) groups (P=0.24) after adjustment for fasting plasma glycemia, central foveal thickness, green vegetables, Chinese wolfberry, carotene and vitamin E. For all the 401 participants included, MPOD was positively associated with central foveal thickness (E=0.0007, P=0.001), Chinese wolfberry (E=0.0345, P=0.01), and green vegetables (E=0.0596, P<0.001) intake. CONCLUSION: The data suggest that MPOD level is not statistically significantly influenced by the onset of diabetes or early stage of DR in the studied population. MPOD level is positively associated with thicker central foveal thickness and higher intake of foods containing carotenoids.

12 Effect of focal laser photocoagulation in eyes with mild to moderate non-proliferative diabetic retinopathy

Seong Hun Jeong , Jung Il Han , Sung Won Cho , Dong Won Lee , Chul Gu Kim , Tae Gon Lee , Jong Woo Kim

2016, 9(10):1439-1443. DOI: 10.18240/ijo.2016.10.12

[Abstract](1674) [HTML](0) [PDF 434.08 K](568)

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AIM: To report the effect of focal laser photocoagulation on both the severity of hard exudates (HEs) and the rate of disease progression in eyes with mild to moderate non-proliferative diabetic retinopathy (NPDR). METHODS: We retrospectively reviewed the medical records of 33 patients (60 eyes) who had been diagnosed with mild to moderate NPDR between January 2006 and December 2012. The patients were divided into 2 groups: Group A (38 eyes in 20 patients treated using focal laser photocoagulation) and Group B (treated without laser photocoagulation). We also reviewed the best corrected visual acuity measurements, and the fundus photographs taken at both baseline and follow-up visits. RESULTS: In Group A, HE severity grade had decreased significantly from baseline to the final visit (P<0.05), but this was not the case in Group B (P=0.662). The cumulative probabilities of retinopathy progression at 5y were 26% in Group A and 30% in Group B. Kaplan-Meier survival curves showed no significant difference between the groups with regard to retinopathy progression (P=0.805). CONCLUSION: Focal laser photocoagulation reduced the levels of HEs in eyes with mild to moderate NPDR. However, the treatment was not able to decelerate the progression of DR.

13 Clinical research of fenofibrate and spironolactone for acute central serous chorioretinopathy

Yong Chai , Rong-Qiang Liu , Jing-Lin Yi , Ling-Hong Ye , Jing Zou , Nan Jiang , Yi Shao

2016, 9(10):1444-1450. DOI: 10.18240/ijo.2016.10.13

[Abstract](1671) [HTML](0) [PDF 484.73 K](716)

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AIM: To compare the effectiveness of combined fenofibrate and spironolactone with fenofibrate alone for treatment of central serous chorioretinopathy (CSCR). METHODS: Totally 60 patients (60 eyes) with a history of acute CSCR were randomed into two groups: group A with combination of fenofibrate (200 mg) and spironolactone (100 mg), and group B with only fenofibrate (200 mg). They were taken half an hour before meals and once per day for 8wk. The changes of the visual acuity, subjective symptom, ocular surface disease index (OSDI), the tear film and optical coherence tomography were observed at 2, 4, 6, and 8wk before and after treatment. RESULTS: The best corrected visual acuity (BCVA, logMAR) was improved to 0.22 and 0.27 after treatment from baseline of 0.35 and 0.36 in groups A and B (P<0.05), respectively. After 8wk treatment, the central subfield thickness (CST), and subretinal fluid volumn (SFV) decreased significantly to 49.5% and 78.8% in group A and 37.0% and 57.2% in group B. There were significant differences of CST and SFV in both groups (all P<0.05). CONCLUSION: Fenofibrate combined with spironolactone may have more clinical efficacy in the treatment of CSCR than fenofibrate only.

14 Peripapillary choroidal thickness in Chinese children using enhanced depth imaging optical coherence tomography

Xi-Shi Wu , Li-Jun Shen , Ru-Ru Chen , Zhe Lyu

2016, 9(10):1451-1456. DOI: 10.18240/ijo.2016.10.14

[Abstract](1455) [HTML](0) [PDF 610.40 K](658)

Abstract:
AIM: To evaluate the peripapillary choroidal thickness (PPCT) in Chinese children, and to analyze the influencing factors. METHODS: PPCT was measured with enhanced depth imaging optical coherence tomography (EDI-OCT) in 70 children (53 myopes and 17 non-myopes) aged 7 to 18y, with spherical equivalent refractive errors between 0.50 and -5.87 diopters (D). Peripapillary choroidal imaging was performed using circular scans of a diameter of 3.4 mm around the optic disc. PPCT was measured by EDI-OCT in six sectors: nasal (N), superonasal (SN), superotemporal (ST), temporal (T), inferotemporal (IT) and inferonasal (IN), as well as global RNFL thickness (G). RESULTS: The mean global PPCT was 165.49±33.76 µm. The temporal, inferonasal, inferotemporal PPCT were significantly thinner than the nasal, superonasal, superotemporal segments PPCT were significantly thinner in the myopic group at temporal, superotemporal and inferotemporal segments. The axial length was significantly associated with the average global (β= -0.419, P=0.014), superonasal (β= -2.009, P=0.049) and inferonasal (β= -2.000, P=0.049) PPCT. The other factors (gender, age, SE) were not significantly associated with PPCT. CONCLUSION: PPCT was thinner in the myopic group at temporal, superotemporal and inferotemporal segments. The axial length was found to be negatively correlated to PPCT. We need more further studies about the relationship between PPCT and myopia.

15 Evaluation of patients with dry eye disease for conjunctival Chlamydia trachomatis and Ureaplasma urealyticum

Maha Mohssen Abdelfattah , Rania Abdelmonem Khattab , Magda H. Mahran , Ebrahim S. Elborgy

2016, 9(10):1457-1465. DOI: 10.18240/ijo.2016.10.15

[Abstract](2109) [HTML](0) [PDF 983.71 K](654)

Abstract:
AIM: To determine the possibility of the development of dry eye disease (DED) as a result of persistent infection with Chlamydia trachomatis and Ureaplasma urealyticum in the conjunctiva of patients. METHODS: This study was conducted on 58 patients of age range 20-50y, diagnosed with DED confirmed by Schirmer I test and tear breakup time. The non-dry eye control group included 27 subjects of the same age. Ocular specimens were collected as conjunctival scrapings and swabs divided into three groups: the first used for bacterial culture, the second and third taken to detect Chlamydia trachomatis and Ureaplasma urealyticum by direct fluorescent antibody (DFA) assay and polymerase chain reaction (PCR) method. RESULTS: Chlamydia trachomatis was detected in 65.5% and 76% of DED patients by DFA and PCR methods respectively. Ureaplasma urealyticum was found in 44.8% of DED infected patients using the PCR method. Both organisms were identified in only 37.9% of DED patients found to be infected. Control subjects had a 22% detection rate of Chlamydia trachomatis by DFA assay versus a 7% detection rate by PCR; while Ureaplasma urealyticum was detected in 3.7% of the controls by PCR method. The conjunctival culture revealed that gram positive microorganisms represented 75% of isolates with coagulase negative Staphylococci the most common (50%) followed by Staphylococcus aureus (20%), whereas gram negative microorganisms occurred in 25% of cases, isolating Moraxella spp. as the most frequent organism. CONCLUSION: Our results tend to point out that Chlamydia trachomatis and Ureaplasma urealyticum were detected in a moderate percentage of patients with DED, and could be a fair possibility for its development. PCR is more reliable in detecting Chlamydia trachomatis than DFA technique. The presence of isolated conjunctival bacterial microflora can be of some potential value.

16 Bicanalicular versus monocanalicular intubation after failed probing in congenital nasolacrimal duct obstruction

Mohammad Taher Rajabi , Najmeh Zavarzadeh , Alireza Mahmoudi , Mohammad Karim Johari , Seyedeh Simindokht Hosseini , Yalda Abrishami , Mohammad Bagher Rajabi

2016, 9(10):1466-1470. DOI: 10.18240/ijo.2016.10.16

[Abstract](1476) [HTML](0) [PDF 256.24 K](583)

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AIM: To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing. METHODS: This retrospective study was performed on 338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing. Intubation was performed under light sedation in operating room and the stent was left 3mo in place. Clinical outcome was investigated 3mo after tube removal. RESULTS: Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation (P=0.00). In addition, Monoka intubation had better outcomes compared to Masterka technique (P=0.046). No difference was found between genders but the higher the age, the better the outcomes with bicanalicular technique rather than monocanalicular. CONCLUSION: Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages. Also, based upon our clinical outcomes, Masterka intubation is not recommended in cases of failed probing.

17 Outcomes of endoscopic endonasal dacryocystorhinostomy for intractable lacrimal dacryostenosis and associated factors

Tohru Tanigawa , Hirokazu Sasaki , Hiroshi Nonoyama , Yuichiro Horibe , Kunihiro Nishimura , Tetsuro Hoshino , Tetsuya Ogawa , Kenta Murotani , Hiromi Ueda , Masahiro Kaneda

2016, 9(10):1471-1475. DOI: 10.18240/ijo.2016.10.17

[Abstract](1369) [HTML](0) [PDF 265.61 K](706)

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AIM: To examine the effects of patient age, canalicular obstruction, mode of anesthesia, and duration of nasolacrimal intubation on the outcomes of endoscopic endonasal dacryocystorhinostomy (DCR). METHODS: Totally 56 eyes of 46 patients with prolonged epiphora underwent minimally invasive endoscopic endonasal DCR. A successful surgical outcome was defined as a significant improvement in symptoms, adequate water passage from the puncta to the nasal cavity, and patency of the DCR ostium. All outcomes were assessed at least 6mo after extubation. Fisher’s exact test was used to discuss the factors, and then the logistic regression analysis was made by SAS 9.4 software. RESULTS: The overall success rate was 75.0%, and complete resolution was observed in 27 eyes. The success rate was higher for patients with ≥6mo intubation than for those with <6mo intubation. However, there were no significant differences in outcomes between groups stratified by age (<65 or ≥65y), presence or absence of canalicular obstruction, mode of anesthesia (local or general), and use or nonuse of a radiowave unit. One patient developed subcutaneous emphysema around the eye and nose and one developed subcutaneous hemorrhage after surgery. CONCLUSION: Endoscopic endonasal DCR can be considered safe and minimally invasive with reasonable success rates, particularly when the duration of nasolacrimal intubation is ≥6mo.

18 Prevalence and characteristics of ophthalmological extra-intestinal manifestations in Chinese patients with inflammatory bowel disease

Ying-Chao Li , Wei-Zhi Li , Chang-Rui Wu , Yun Feng , Li Ren , Chen Mi , Yang Li

2016, 9(10):1476-1479. DOI: 10.18240/ijo.2016.10.18

[Abstract](1337) [HTML](0) [PDF 231.35 K](588)

Abstract:
AIM: To investigate the prevalence of ophthalmological extra-intestinal manifestations (O-EIMs) in Chinese patients with inflammatory bowel disease (IBD) and to identify risk factors for the development of O-EIMs. METHODS: The study population consisted of Chinese patients with a definite diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) in a large teaching hospital between January 1995 and December 2014. Demographic and clinical characteristics of patients were extracted retrospectively. RESULTS: In this twenty-year cohort, 645 IBD patients (517 with UC, 128 with CD) were registered. Among them 122 (18.9%) exhibited at least one EIM. Of 13 patients (2.0%) developed O-EIMs, 7 of CD (5.5%) and 6 of UC (1.2%). Clinical ophthalmological manifestations included redness (76.9%), burning (61.5%), pain (38.5%), itching (15.4%) of eyes and vision change (7.7%). O-EIMs included episcleritis (7), uveitis (5) and dry eye (1). O-EIMs were more prevalent in female (odds ratio for male 0.61, 95% confidence interval 0.52-0.73, P<0.0001), and patients who had IBD diagnosis at young age (odds ratio for patients aged >30 years 0.76, 95% confidence interval 0.65-0.88, P<0.0001). CONCLUSION: The frequency of O-EIMs in Chinese patients with IBD is lower than the rates reported in the studies of European and American countries. Episcleritis and uveitis are the most common O-EIMs. O-EIMs are more frequent in patients with CD and more prevalent in female and patients who have IBD diagnosis at young age.

19 Smoking and the risk of dry eye: a Meta-analysis

Li Xu , Wei Zhang , Xiao-Yu Zhu , Tao Suo , Xian-Qun Fan , Yao Fu

2016, 9(10):1480-1486. DOI: 10.18240/ijo.2016.10.19

[Abstract](2170) [HTML](0) [PDF 805.58 K](908)

Abstract:
AIM: To collect the evidence to estimate the correlation between smoking and the incidence of dry eye. METHODS: The PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL, last issue), CBM (Chinese BioMedical Literature Database), and CNKI (China National Knowledge Infrastructure/Chinese Academic Journals full-text Database) were searched for eligible studies published from January 1964 to December 2015 to investigate the association of smoking with the risk of dry eye. The odds ratio (OR) and 95% confidence interval (CI) were summarized and calculated. The extracted studies were pooled by the fixed-effects model or a random-effects model. RESULTS: Two cohort studies and eight cross-sectional surveys were included in our Meta-analysis. There was no statistically significant relationship between current (OR=1.32; 95% CI: 0.99-1.76; P=0.055) or ever smoking (OR=1.12; 95% CI: 0.98-1.28; P=0.107) and the risk of dry eye among the studies, even when age and gender were adjusted (OR=1.16; 95% CI: 0.83-1.64; P=0.383). In the sensitivity analysis in which only general population were included, the association was significant between smoking and dry eye (OR=1.50; 95% CI: 1.08-2.09; P=0.016). CONCLUSION: This Meta-analysis suggests that smoking may associate with the risk of dry eye in general population.

20 Alcohol consumption and dry eye syndrome: a Meta-analysis

Yong-Sheng You , Nai-Bin Qu , Xiao-Ning Yu

2016, 9(10):1487-1492. DOI: 10.18240/ijo.2016.10.20

[Abstract](1796) [HTML](0) [PDF 648.26 K](605)

Abstract:
AIM: To quantify the association between alcohol consumption and dry eye syndrome (DES) with Meta-analysis of published case-control and cross-sectional studies. METHODS: Three databases were screened for potentially eligible studies through Nov. 30, 2015, PubMed, Web of Science, and the Cochrane Library. Odds ratios (ORs) were pooled with 95% confidence intervals (CIs) to evaluate the relationship between alcohol consumption and DES risk. Subgroup analyses were performed according to diagnostic criteria, publication year, sample size, alcohol intake and adjusted factors. RESULTS: A total of 10 (9 case-control and 1 cross-sectional) studies from 8 articles were included in this Meta-analysis. The pooled results showed that alcohol consumption would significantly increase the risk of DES (OR 1.15, 95% CI: 1.02-1.30), and the results were independent of smoking, hypertension, diabetes and thyroid disease history. And the results of subgroup analyses indicated an increased incidence of DES diagnosed by typical DES symptoms and positive objective tests together (OR 1.18, 95% CI: 1.01-1.39) among drinkers, but not by typical DES symptoms alone (OR 1.11, 95% CI: 0.94-1.32). What’s more, any drinkers were at higher risk of suffering from DES (OR 1.33, 95% CI: 1.31-1.34), while heavy drinkers not (OR 1.01, 95% CI: 0.86-1.18). CONCLUSION: The present Meta-analysis suggests that alcohol consumption may be a significant risk factor for DES. Alcohol-induced peripheral neuropathymay falsely reduce the prevalence of DES among heavy drinkers. Future prospective studies of alcohol consumption and DES risk are needed to confirm our results.

21 A Meta-analysis of the association between different genotypes (G11778A, T14484C and G3460A) of Leber hereditary optic neuropathy and visual prognosis

Dong-Yu Guo , Xia-Wei Wang , Nan Hong , Yang-Shun Gu

2016, 9(10):1493-1498. DOI: 10.18240/ijo.2016.10.21

[Abstract](1901) [HTML](0) [PDF 956.56 K](684)

Abstract:
AIM: To analyze the influences of different genotypes (G11778A, T14484C and G3460A) of Leber hereditary optic neuropathy (LHON) on visual prognosis. METHODS: After a systematic literature search, all relevant studies evaluating the association between the three primary mutations of LHON and visual prognosis were included. All statistical tests were calculated with Revman 5.2 and STATA 12.0. RESULTS: Ten independent studies were included finally. A significant association between the three primary mutations and prognostic vision over 0.3 were found in G11778A versus T14484C [odds ratio (OR)=0.10, 95% confidence interval (CI)=0.05-0.17, P<0.001], G11778A versus G3460A (OR=0.18, 95%CI=0.09-0.37, P<0.001) and T14484C versus G3460A (OR=2.45, 95%CI=1.10-5.48, P<0.05). In addition, obtained by pairwise comparison, the vision during onset, age of onset and sex ratio of these three kinds of patients, have no statistical significance (P>0.05). CONCLUSION: From pairwise comparison, we conclude that these three different genotypes of LHON are related to patients’ visual prognosis. The T14484C patients might have a best prognostic vision, G3460A second, and G11778A worst. And there is little relation between the three different genotypes and patients’ vision, age of onset and sex ratio.

22 Analysis on sports and recreation activity-related eye injuries presenting to the Emergency Department

Sungbae Moon , Hyun Wook Ryoo , Jae Yun Ahn , Jung Bae Park , Kang Suk Seo , Sang Do Shin , Kyoung Jun Song , Kang Hyun Lee , In Sool Yoo , Jin Seong Cho , Hyun Ho Ryu , Tae Oh Jeong , Seok Ran Yeom , Young Taek Kim , Sung Ok Hong

2016, 9(10):1499-1505. DOI: 10.18240/ijo.2016.10.22

[Abstract](1852) [HTML](0) [PDF 412.02 K](697)

Abstract:
AIM: To investigate the incidence and general characteristics of sports-related eye injuries in patients visiting the Emergency Department. METHODS: A cross-sectional, multi-center, observational study. Patients with an injured eye who visited the Emergency Department at one of nine hospitals in Korea were enrolled. All data were prospectively collected between March and September 2010 using a questionnaire. Eye injuries that occurred during risky sports were examined by gender and age. Additionally, the rate of open globe injuries that occurred with and without protective eyewear was examined for each activity. Continuous variables were compared using Student’s t-test and categorical variables were compared using Chi-square test. RESULTS: A total of 446 patients had sports-related eye injuries. Teenagers (10-19 years old) and young adults (20-29 years old) had the most eye injuries. Eye injuries accounted for 0.2% of Emergency Department patients. Baseball was the most common cause of sports-related eye injuries, followed by soccer and hiking. Protective gear was worn by 9.4% of all patients. Patients that were 30-39 years of age had the highest rate of protective gear use, followed by patients that were 40-49 years of age. The proportion of sports-related eye injuries that were open-globe injuries was highest for soccer and hiking. CONCLUSION: Although injuries were most common in patients below the age of 10 years, these patients had the lowest rate of protective eyewear use. Injuries in adults over 40 years of age most commonly occurred during hiking, but the rate of protective eyewear use was low. Young athletes should be educated on and provided with protective eyewear and policies protective gear use should be established. For older adults, eye protection should be encouraged, especially during hiking.

Nicola Pescosolido , Andrea Barbato , Rossella Giannotti , Chiara Komaiha , Fiammetta Lenarduzzi

2016, 9(10):1506-1517. DOI: 10.18240/ijo.2016.10.23

[Abstract](3539) [HTML](0) [PDF 646.50 K](864)

Abstract:
The crystalline lens is a transparent, biconvex structure in the eye that, along with the cornea, helps to refract light to be focused on the retina and, by changing shape, it adjusts focal distance (accommodation). The three classes of structural proteins found in the lens are α, β, and γ crystallins. These proteins make up more than 90% of the total dry mass of the eye lens. Other components which can be found are sugars, lipids, water, several antioxidants and low weight molecules. When ageing changes occur in the lens, it causes a gradual reduction in transparency, presbyopia and an increase in the scattering and aberration of light waves as well as a degradation of the optical quality of the eye. The main changes that occur with aging are: 1) reduced diffusion of water from the outside to the inside of the lens and from its cortical to its nuclear zone; 2) crystalline change due to the accumulation of high molecular weight aggregates and insoluble proteins; 3) production of advanced glycation end products (AGEs), lipid accumulation, reduction of reduced glutathione content and destruction of ascorbic acid. Even if effective strategies in preventing cataract onset are not already known, good results have been reached in some cases with oral administration of antioxidant substances such as caffeine, pyruvic acid, epigallocatechin gallate (EGCG), α-lipoic acid and ascorbic acid. Furthermore, methionine sulfoxide reductase A (MSRA) over expression could protect lens cells both in presence and in absence of oxidative stress-induced damage. Nevertheless, promising results have been obtained by reducing ultraviolet-induced oxidative damage.

24 Decreased paraoxonase1 activity and increased malondialdehyde and oxidative DNA damage levels in primary open angle glaucoma

Ugur Yilmaz Mumcu , Ibrahim Kocer , Orhan Ates , H. Hakan Alp

2016, 9(10):1518-1520. DOI: 10.18240/ijo.2016.10.24

[Abstract](1622) [HTML](0) [PDF 197.47 K](631)

Abstract:
To investigate the malondialdehyde (MDA) levels, paraoxonase1 (PON1) activity and 8-hydroxy 2-deoxyguanosine (8-OHdG) levels in the primary open angle glaucoma (POAG) patient. Blood samples from 52 healthy individuals and 53 patients with POAG were analyzed for MDA and 8-OHdG by HPLC (high-performance liquid chromatography) and PON1 by spectrophotometry. The data obtained were analyzed statistically. MDA levels were 10.46±8.4 and 4.70±1.79 μmol; PON1 levels were 121±39.55 and 161.62±60.22 U/mL; and 8-OHdG values were 1.32±0.53/106 dG and 0.47±0.27/106 dG in the POAG patients and the control group, respectively. The difference was significant in MDA levels, 8-OHdG levels and PON1 activity in POAG patients in comparison with controls (P<0.001). We concluded that the observed increase in MDA and 8-OHdG levels may be correlated with decreased PON1 activity. Oxidative stress plays an important role in glaucoma development.

25 Preoperative evaluation of human crystalline lens hardness using A-scan ultrasound biometry: a pilot study

Konstantinos T Tsaousis , Lampros P Lamprogiannis , Stavros A Dimitrakos , Ioannis T Tsinopoulos

2016, 9(10):1521-1523. DOI: 10.18240/ijo.2016.10.25

[Abstract](1333) [HTML](0) [PDF 373.97 K](612)

Abstract:
Letter to the editor

26 Dexamethasone intravitreal implant for diabetic macular edema in a pregnant patient

Romi Yoo , Hyung Chan Kim , Hyewon Chung

2016, 9(10):1524-1527. DOI: 10.18240/ijo.2016.10.26

[Abstract](1240) [HTML](0) [PDF 458.09 K](645)

Abstract:
Letter to the editor

27 Visual function alterations in cavernous hemangioma of the orbital apex after surgery

Kang Xue , Min Wang , Jiang Qian

2016, 9(10):1528-1531. DOI: 10.18240/ijo.2016.10.27

[Abstract](1232) [HTML](0) [PDF 523.51 K](566)

Abstract:
Letter to the editor

28 Comment on survival analysis following early surgical success in intermittent exotropia surgery

Onder Ayyildiz , Gokhan Ozge , Cem Ozgonul , Gokcen Gokce , Fatih Mehmet Mutlu

2016, 9(10):1532-1534. DOI: 10.18240/ijo.2016.10.28

[Abstract](1245) [HTML](0) [PDF 125.90 K](553)

Abstract:
Comment and Response

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Volume 9,Issue 10,2016 Table of Contents