Volume 13,Issue 2,2020 Table of Contents

1 Expression and role of aryl hydrocarbon receptor in Aspergillus fumigatus keratitis

Li Zhang , Nan Jiang , Gui-Qiu Zhao , Xu-Dong Peng , Guo-Qiang Zhu , Wei Jiang , Jing-Jing Ma

2020, 13(2):199-205. DOI: 10.18240/ijo.2020.02.01

[Abstract](1533) [HTML](0) [PDF 1.21 M](867)

Abstract:
AIM: To observe the expression and role of aryl hydrocarbon receptor (AhR) in the immune response of mouse cornea infected with Aspergillus fumigatus (A. fumigatus). METHODS: Murine models of A. fumigatus keratitis were established by scraping the central epithelium of mouse cornea, daubing A. fumigatus on the cornea and covering with a contact lens. The mice were randomly divided into the control group and the A. fumigatus-infected (A.F.) group for 1, 3 and 5d respectively, which corneas were daily monitored by a slit lamp microscope and the clinical scores were also recorded timely after infection. In this study, immunofluorescence staining was used to detect the expression and localization of AhR in mouse corneas, and the mRNA and protein of AhR were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot. In addition, mouse peritoneal macrophages were stimulated by A. fumigatus with or without the pretreatment of AhR antagonist CH223191 and AhR agonist FICZ, and the tumor necrosis factor alpha (TNF-α), inducible nitric oxide synthase (iNOS), interleukin-10 (IL-10) and Arg-1 mRNA were detected by RT-PCR. RESULTS: According to the results of the slit light photography, it was clearly indicated that the corneal inflammation were the most severe and the clinical score became the highest as well on the 3rd day after the infection of A. fumigatus. Contrasted with the control group, the expression of AhR in the corneal epithelial cells infected with A. fumigatus was significantly increased detected by immunofluorescence staining. AhR mainly expressed in the nucleus and cytoplasm of corneal epithelial cells. Consistent with the transcriptional level of AhR mRNA, the expression level of AhR protein reached the peak on the 3rd day after infection which was detected by Western blot. Furthermore, RT-PCR showed that CH223191 up-regulated the expression of TNF-α and iNOS and down-regulated the expression of IL-10 and Arg-1 in peritoneal macrophages; inversely, FICZ reduced the expression of TNF-α and iNOS while elevated the expression of IL-10 and Arg-1. CONCLUSION: AhR is involved in the pathogenesis of A. fumigatus keratitis and induced immune protection in anti-A. fumigatus immune response by inhibiting M1 and increasing M2 phenotype macrophage-related inflammatory factors.

2 Netrin-1 promotes epithelium repair in corneal injury

Yun Han , Nan Jiang , Ting Su , Qi-Chen Yang , Cong-Cong Yan , Lei Ye , Qing Yuan , Pei-Wen Zhu , Wei Li , Zu-Guo Liu , Yi Shao

2020, 13(2):206-212. DOI: 10.18240/ijo.2020.02.02

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AIM: To explore netrin-1 functions on corneal epithelium in vitro and in vivo. METHODS: In vitro the human corneal epithelial (HCE) cells were treated with serum free DMEM-F12 basic media containing 0, 50, 100, 200, 300, 500, 800, and 1000 ng/mL of netrin-1, respectively. The cells viability was detected by cell counting kit-8 (CCK-8). The wound-healing assay was applied to assess the migration proficiency of HCE cells. Flow cytometry was used to analyze the cell-cycle distribution and apoptosis. In vivo, normal c57 (6wk) mice were demarcated with a trephine in the middle of the cornea to produce a 3-mm circular wound. Mice corneas were inflicted no epithelium with a 3-mm wound displayed, but remained the limbal epithelium intact. A blunt scalpel blade was used to remove the corneal epithelian cells, followed by topical netrin-1 application (200 ng/mL), and the group treated by PBS as control. The treated group was injected netrin-1 into the normal c57 mice inferior subconjunctival 4h before trauma. Mouse corneal inflammation and neovascularization were observed under slit lamp microscope. The apoptosis of corneal cells was determined by TUNEL staining. CONCLUSION: Netrin-1 can reduce HCE apoptosis as well as promote its proliferation and migration. Topical application of netrin-1 promotes the injuryed cornea epithelial wound repair and inhibits apoptosis of corneal epithelial cells. These findings may offer potential therapies to repair the defects of corneal epithelial based on netrin-1.

3 Targeting long non-coding RNA MALAT1 alleviates retinal neurodegeneration in diabetic mice

Yu-Lan Zhang , Han-Ying Hu , Zhi-Peng You , Bing-Yang Li , Ke Shi

2020, 13(2):213-219. DOI: 10.18240/ijo.2020.02.03

[Abstract](1600) [HTML](0) [PDF 1.46 M](724)

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AIM: To observe the effect of inhibiting long non-coding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) on diabetic neurodegeneration. METHODS: Thirty-six 8-week-old C57BL/6 mice were randomly divided into normal control, diabetic control, diabetic scrambled small interfering RNAs (siRNAs) and diabetic MALAT1-siRNA groups. After diabetic induction with streptozocin intraperitoneally-injection, the diabetic MALAT1-siRNA group was intravitreally injected with 1 μL 20 μmol/L MALAT1 siRNA, and the diabetic scrambled siRNA group was injected with the same amount of scrambled siRNA. Electroretinography was performed to examine photoreceptor functions 16wk after diabetes induction. MALAT1 expression was detected via real time polymerase chain reaction. Cone morphological changes were examined using immunofluorescence. Rod morphological changes were examined by determining outer nuclear layer (ONL) thickness. RESULTS: The upregulation of retinal MALAT1 expression was detected in the diabetic control mice, while MALAT1 expression in the diabetic MALAT1-siRNA mice was decreased by 91.48% compared to diabetic control mice. The diabetic MALAT1-siRNA and diabetic control mice showed lower a-wave and b-wave amplitudes than did the normal control mice in scotopic and photopic electroretinogram, while the diabetic MALAT1-siRNA mice showed higher amplitudes than diabetic control mice. Morphological examination revealed that ONL thickness in the diabetic MALAT1-siRNA and diabetic control mice was lower than normal control mice. However, ONL thickness was greater in the diabetic MALAT1-siRNA mice than diabetic control mice. Moreover, the diabetic control mice performed a sparser cone cell arrangement and shorter outer segment morphology than diabetic MALAT1-siRNA mice. CONCLUSION: Inhibiting retinal MALAT1 results in mitigative effects on the retinal photoreceptors, thus alleviating diabetic neurodegeneration.

4 Simultaneous expression of two pathogenic genes in four Chinese patients affected with inherited retinal dystrophy

Xiao-Zhen Liu , Tian-Chang Tao , Hong Qi , Shan-Na Feng , Ning-Ning Chen , Lin Zhao , Zhi-Zhong Ma , Gen-Lin Li , Li-Ping Yang

2020, 13(2):220-230. DOI: 10.18240/ijo.2020.02.04

[Abstract](1236) [HTML](0) [PDF 7.93 M](788)

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AIM: To describe the complex, overlapping phenotype of four Chinese patients with inherited retinal dystrophies (IRDs) who harbored two pathogenic genes simultaneously. METHODS: This retrospective study included 4 patients affected with IRDs. Medical and ophthalmic histories were obtained, and clinical examinations were performed. A specific Hereditary Eye Disease Enrichment Panel (HEDEP) based on exome capture technology was used for genetic screening. RESULTS: Four patients were identified to harbor disease-causing variants in two different genes. Patient retinitis pigmentosa (RP) 01-II:1 exhibited both classical ABCA4 -induced Stargardt disease (STGD) 1 and USH2A-associated RP, patient RP02-III:2 exhibited both classical ABCA4-induced STGD1 and CDH23-associated RP, patient RP03-II:1 exhibited both USH2A-induced autosomal recessive retinitis pigmentosa (arRP) syndrome and SNRNP200-induced autosomal dominant retinitis pigmentosa (adRP), and patient RP04- II:2 exhibited USH2A-induced arRP syndrome and EYS-induced arRP at the same time. CONCLUSION: Our study demonstrates that genotype–phenotype correlations and comprehensive genetic screening is crucial for diagnosing IRDs and helping family planning for patients suffering from the disease.

5 Role of Smad4 from ocular surface ectoderm in retinal vasculature development

Jing Li , Jin-Song Zhang , Jiang-Yue Zhao , Guo-Ge Han

2020, 13(2):231-238. DOI: 10.18240/ijo.2020.02.05

[Abstract](1162) [HTML](0) [PDF 2.72 M](735)

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AIM: To investigate how signals from lens regulate retinal vascular development and neovascularization. METHODS: Le-Cre transgenic mouse line was employed to inactivate Smad4 in the surface ectoderm selectively. Standard histological and whole-mount retina staining were employed to reveal morphological changes of retinal vasculature in Smad4 defective eye. cDNA microarray and subsequent analyses were conducted to investigate the molecular mechanism underlying the vascular phenotype. Quantitative polymerase chain reaction (qPCR) was carried out to verify the microarrays results. RESULTS: We found that inactivation of Smad4 specifically on surface ectoderm leads to a variety of retinal vasculature anomalies. Microarray analyses and qPCR revealed that Sema3c, Sema3e, Nrp1, Tie1, Sox7, Sox17, and Sox18 are significantly affected in the knockout retinas at different developmental stages, suggesting that ocular surface ectoderm-derived Smad4 can signal to the retina and regulates various angiogenic signaling in the retina. CONCLUSION: Our data suggest that the cross-talk between ocular surface ectoderm and retina is important for retinal vasculature development, and Smad4 regulates various signaling associated with sprouting angiogenesis, vascular remodeling and maturation in the retina of mice.

6 Long-term effects of pattern scan laser pan-retinal photocoagulation on diabetic retinopathy in Chinese patients: a retrospective study

Chuang-Xin Huang , Kun-Bei Lai , Li-Jun Zhou , Zhen Tian , Xiao-Jing Zhong , Fa-Bao Xu , Ya-Jun Gong , Lin Lu , Chen-Jin Jin

2020, 13(2):239-245. DOI: 10.18240/ijo.2020.02.06

[Abstract](1082) [HTML](0) [PDF 1.40 M](746)

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AIM: To evaluate the long-term effects of pattern scan laser (PASCAL) pan-retinal photocoagulation (PRP) on diabetic retinopathy (DR) in Chinese patients. METHODS: In this retrospective study, we evaluated clinical data of 29 patients (53 eyes) with severe non-proliferative DR (SNPDR) or proliferative DR (PDR) who received PRP and follow-up at our hospital from 2008 to 2013. Sixteen patients (29 eyes) received PASCAL PRP and 13 patients (24 eyes) received 100-ms conventional laser PRP. RESULTS: After long-term follow-up (mean, min-max days: 719.8, 290-1666 for PASCAL PRP vs 743.5, 240-1348 for conventional PRP, P=0.569), patients receiving PASCAL PRP required fewer photocoagulation sessions than the conventional PRP group (2.6±1.0 vs 3.9±0.9, P<0.01). Best corrected visual acuity (BCVA) was reduced slightly in PASCAL PRP group while reduced significantly in conventional PRP group. At last visit, 24 eyes in the PASCAL group (88.9%) and 21 eyes in the conventional group (91.7%) were improved or stable. Two eyes in PASCAL PRP group (7.4%) and 3 eyes in the conventional PRP group (12.5%) developed vitreous hemorrhage or vitreous fibrovascular proliferation. CONCLUSION: PASCAL PRP is as effective and may be more conducive to maintaining visual acuity with less treatment sessions for DR treatment compared to conventional laser PRP.

7 Outcomes of 1.8-3.0 mm incision phacoemulsification combined with trabeculectomy for primary angle-closure glaucoma with cataract

Qing Wang , Zheng-Xuan Jiang , Rong-Feng Liao

2020, 13(2):246-251. DOI: 10.18240/ijo.2020.02.07

[Abstract](1096) [HTML](0) [PDF 436.93 K](594)

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AIM: To compare efficacy of coaxial microincisions (1.8 mm, 2.2 mm) and small incisions (3.0 mm) on phacoemulsification combined with trabeculectomy for primary angle-closure glaucoma (PACG) with cataract. METHODS: Ninety-six patients (96 eyes) with PACG and cataract were recruited and randomly divided into three groups between January 2015 and June 2017. Group A (3.0 mm incision), B (2.2 mm incision), and C (1.8 mm incision) comprised 30, 34 and 32 eyes respectively. All cases were treated with clear corneal incision phacoemulsification combined with trabeculectomy. Data including best corrected visual acuity (BCVA), corneal astigmatism, corneal endothelial cell counts (CECC), intraocular pressure (IOP), and complications were collected before the operation, and at postoperative 1d, 1 and 3mo. RESULTS: All the patients were successfully treated with surgery. The BCVA of groups B and C were significantly improved as compared to group A at postoperative 1d, 1 and 3mo (all P<0.05), but there was no difference between groups B and C at each time interval (all P>0.05). The corneal astigmatism of group A was statistically higher than that of group B (P=0.026); corneal astigmatism of group B was statistically higher than that of group C at postoperative 1d (P=0.006). The corneal astigmatism of group A at postoperative 3mo was significantly higher than that before operation (P=0.003). At postoperative 1 and 3mo, corneal astigmatism of groups B and C were significantly lower than that of group A (all P<0.05). The CECC in group B was significantly higher than that of group A (P=0.020), and CECC in group C was significantly higher than that of group B (P=0.034) at postoperative 1d. At postoperative 1 and 3mo, CECC of groups B and C were significantly higher than that of group A (all P<0.05). In each group, postoperative mean IOP at each time interval was significantly lower than preoperative IOP (all P<0.05). CONCLUSION: Coaxial microincision phacoemulsification combined with trabeculectomy for PACG with cataract has better curative efficacy in reducing postoperative corneal astigmatism and corneal endothelial cell injury than traditional small incision combined surgery, and the 1.8 mm microincision has better curative efficacy than 2.2 mm microincision in the early postoperative period.

8 Impact of switching from ranibizumab to aflibercept on the number of intravitreous injection and follow up visit in wet AMD: results of real life ELU study

Frederic Queguiner , Kristina Bezirganyan , Jean Christophe Courjaret , Laurence Curel , Guillaume Penaranda , Maud Righini Chossegros

2020, 13(2):252-256. DOI: 10.18240/ijo.2020.02.08

[Abstract](940) [HTML](0) [PDF 389.09 K](555)

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AIM: To study if one of the two molecules could lead to a lower number of follow up visits and intra-vitreous injection (IVI) with the same efficacy. METHODS: ELU (or “elected” in French) study is a retrospective study conducted in real life in patients presenting suboptimal response after ranibizumab IVI (phase 1) and secondary switched to aflibercept (phase 2). The number of follow up visits and IVI were compared in both phases. Visual acuity (VA) evolution and “switching” reasons were secondary analyzed. RESULTS: We retrospectively included data of 33 patients (38 eyes) with age-related macular degeneration (AMD; mean age: 77±7.7y). The number of monthly follow up visits [median (Q1; Q3)]: was significantly lower with aflibercept (phase 2), respectively 1.0 (0.81; 1.49) visits in phase 1, versus 0.79 (0.67; 0.86) visits in phase 2. The median number of monthly IVI also significantly decreased in phase 2, respectively 0.67 (0.55; 0.90) IVI in phase 1, versus 0.55 (0.45; 0.67) IVI in phase 2. The mean VA evolution (VA final-VA initial) was similar in both phases, (P>0.05). Whatever the reason for “switching” (loss of efficacy, tachyphylaxis, tolerance problems), there was no incidence on VA evolution over the time. CONCLUSION: Our results show that switching from ranibizumab to aflibercept in “suboptimal” patients significantly reduce the number of follow up visits and IVI, with a comparable efficacy. This decrease in visit number could improve patients’ quality of life and reduce surgical risk by reducing the number of injections.

9 Combined intra-arterial chemotherapy and intravitreal melphalan for the treatment of advanced unilateral retinoblastoma

Ting-Yi Liang , Xiu-Yu Zhu , Xu-Ming Hua , Xun-Da Ji , Pei-Quan Zhao

2020, 13(2):257-262. DOI: 10.18240/ijo.2020.02.09

[Abstract](1161) [HTML](0) [PDF 698.39 K](626)

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AIM: To evaluate the efficacy and safety of combined intra-arterial chemotherapy (IAC) and intravitreal melphalan (IVM) for the treatment of advanced unilateral retinoblastoma. METHODS: This retrospective study involved 30 consecutive eyes from 30 Chinese patients with advanced unilateral retinoblastoma. All patients were initially treated with IAC combined with IVM. The clinical status and complications were recorded at each visit. RESULTS: The International Intraocular Retinoblastoma Classification groups were D in 23 eyes and E in 7 eyes. All eyes showed severe cloud vitreous seeds at the first visit. The mean number of IAC cycles and intravitreal injections was 3.2 (range, 3-4) and 6 (range, 1-14), respectively. The median follow-up time was 29mo (range, 7-36mo). Treatment success with regression of the retinal tumor and vitreous seeds was achieved in 29 of 30 eyes (96.7%). Globe salvage was attained in 93.3% (28/30) eyes, and enucleation (n=2) was performed due to neovascular glaucoma and persistent vitreous hemorrhage. Complications included retinal pigment epithelium (RPE) atrophy (n=13; 43%), mild lens opacity (n=7; 23%), vitreous hemorrhage (n=5; 17%) and rhegmatogenous retinal detachment (n=1; 3%). No extraocular tumor extension or metastasis occurred. CONCLUSION: Combined IAC and IVM is effective and safe for the treatment of advanced unilateral retinoblastoma.

10 Altered spontaneous brain activity pattern in patients with ophthalmectomy: an resting-state fMRI study

Bing Zhang , Biao Li , Rong-Qiang Liu , Yong-Qiang Shu , You-Lan Min , Qing Yuan , Pei-Wen Zhu , Qi Lin , Lei Ye , Yi Shao

2020, 13(2):263-270. DOI: 10.18240/ijo.2020.02.10

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AIM: To use the voxel-wise degree centrality (DC) method to explore the underlying functional network brain-activity in patients with ophthalmectomy. METHODS: A total of 32 ophthalmic surgery patients (10 women and 22 men), and 32 healthy subjects (10 women and 22 men) highly matched in gender, age, and the same operation method. Everyone experienced a resting-state functional magnetic resonance imaging scan. The spontaneous brain activity could be assessed by DC. Correlation analysis was used to explore the relationships between the average DC signal values and behavior performance in different regions. Receiver operating characteristic (ROC) curve analysis was utilized to differentiate between ophthalmectomy patients and healthy controls (HCs). RESULTS: Compared with HCs, ophthalmectomy patients had greatly reduced DC values in left lingual gyrus, bilateral lingual lobe, left cingulate gyrus, and increased DC values of left cerebellum posterior lobe, left middle frontal gyrus1, right supramarginal gyrus, left middle frontal gyrus2, right middle frontal gyrus. However, we did not find that there was a correlation between the average DC values from various brain regions and clinical manifestations. CONCLUSION: Dysfunction may be caused by ophthalmectomy in lots of cerebral areas, which may show the potential pathological mechanism of ophthalmectomy and it is beneficial to clinical diagnosis.

11 One year results of presbyLASIK using hybrid bi-aspheric micro-monovision ablation profile in correction of presbyopia and myopic astigmatism

Fang Liu , Ting Zhang , Quan Liu

2020, 13(2):271-277. DOI: 10.18240/ijo.2020.02.11

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AIM: To analyze one year clinical outcomes and subjective rating of hybrid bi-aspheric multifocal central presbyLASIK with micro-monovision for correction of presbyopia and myopic astigmatism. METHODS: Seventy-four eyes of 37 patients consecutively treated with presbyLASIK were assessed. The mean age of the patients was 43.8±3.0y with a mean spherical equivalent refraction of -5.21±1.87 diopters (D) and mean astigmatism of -0.82±0.64 D. Visual acuity, manifest refraction, contrast sensitivity, aberrometry and patients’ subjective rating were evaluated pre- and postoperatively. RESULTS: At 1y postoperatively (68 eyes of 34 patients), the mean spherical equivalent (SE) refraction in distance eyes was 0.06±0.05 D, whereas the achieved SE in near eyes was -0.83±0.05 D. Ninety-nine percent of eyes were within ±0.50 D of target correction of SE. The binocular mean uncorrected distance visual acuity (UDVA) was 0.00±0.18 logMAR (20/20). Sixty-four percent of patients achieved 0.0 logMAR (20/20) or better of UDVA and 0.1 logRAD or better of UNVA as well. There was a binocularly loss of one line CDVA after surgery for only one patient (3%, 1/34) and no patient lost 2 lines. The changes in binocular contrast sensitivity (CS) in all test conditions were not significant at any frequency after surgery. The changes of entire eye total higher order aberrations (tHOA) and spherical aberrations (SA) significantly higher in near eyes than in distance eyes. The overall satisfaction score for surgery was 93±8. CONCLUSION: The hybrid bi-aspheric multifocal central presbyLASIK with micro-monovision appears to be an efficacious option for myopic presbyopes. One year postoperative outcomes in a relatively young presbyopia population indicate improvements in both far and near vision with high satisfaction.

12 Treatment modalities in Duane’s Retraction Syndrome

Karim A Gaballah , Dalal Shawky

2020, 13(2):278-283. DOI: 10.18240/ijo.2020.02.12

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AIM: To study the different treatment modalities needed in cases of Duane’s Retraction Syndrome (DRS). METHODS: This prospective study undergone in more than four years, in Alexandria, included 238 patients of DRS, including type I, 162 patients (68%), type II 12 patients (5%) and type III 64 patients (27%). Surgery was indicated in 98 (41%) of them, to eliminate abnormal head posture, deviation of the eye in primary position, severe retraction of the globe or cosmetically unacceptable upshoot with attempted adduction. RESULTS: Type I was the most common and type II was the least. Females were predominant in this study, constituting 125 patients (52.5%), and males 113 patients (47.5%). Left eye was more affected, in 110 patients (46.2%), right eye in 91 patients (38.2%) and bilateral in 37 patients (15.6%). Amblyopia was found in 27 patients (11.3%) and treated in 13 patients under 10 years of age, by patching the normal eye. Ninety-eight patients (41%) were operated, the results were most satisfactory and a nomogram is followed in the surgical plan. CONCLUSION: The surgical management is needed in less than half of the cases and should be planned for every case individually according to the clinical findings, planned nomogram and modified intraoperatively according to the anatomical findings during surgery.

13 A computerized resolution visual acuity test in preschool and school age children

Ying-Yan Qin , Zhen-Zhen Liu , Li-Yuan Zhu , Xuan Bao , Fu-Rong Luo , Yi-Zhi Liu , Young Tsau , Ming-Xing Wu

2020, 13(2):284-291. DOI: 10.18240/ijo.2020.02.13

[Abstract](1181) [HTML](0) [PDF 1.04 M](605)

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AIM: To develop a novel approach called the Autoacuity Tester, and to evaluate its validity, especially the sensitivity and specificity for detecting amblyopia. METHODS: Children aged from 3 to 12y (n=552) were enrolled in the study. The validity of the Autoacuity Tester was evaluated by comparing it to the Tumbling E Early Treatment Diabetic Retinopathy Study (ETDRS) acuity chart for school age children, and Lea Symbols and Teller acuity card (TAC) for preschool children. The repeatability was assessed by coefficient of repeatability (COR). The sensitivity and specificity for detecting amblyopia were calculated. RESULTS: The mean difference (95% limits of agreement) between the Autoacuity Tester and the ETDRS tests were -0.03 (-0.24, 0.19) logMAR for the school age group. In preschool children, the mean difference was 0.04 (-0.14, 0.21) logMAR between the Autoacuity Tester and the TAC and 0.00 (-0.17, 0.18) logMAR between the Autoacuity Tester and the Lea Symbols. For the school age group, the COR was 0.20 logMAR for the Autoacuity Tester and 0.18 logMAR for the ETDRS. For the preschool group, the COR was 0.13 logMAR for the Autoacuity Tester and 0.21 logMAR for TAC. The Autoacuity Tester (88%) is more sensitive than TAC (72%) in detecting amblyopia (P=0.04), while had similar specificity (92% vs 90%, P=0.20). CONCLUSION: The Autoacuity Tester provides a reliable alternative for assessing visual acuity, and offers advantage of higher testability and repeatability for preschool children.

14 Clinical characteristics of asymptomatic Terson syndrome in the patients with aneurysmal subarachnoid hemorrhage

Hae Min Kang , Jin Mo Cho , So Yeon Kim , Jeong Hoon Choi

2020, 13(2):292-300. DOI: 10.18240/ijo.2020.02.14

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AIM: To investigate clinical characteristics of asymptomatic Terson syndrome and its clinical impact in patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: This retrospective, interventional study included 31 patients with aneurysmal SAH, and the medical records were reviewed. In addition to baseline characteristics of the study population such as age, sex, and underlying medical history, multi-modal imaging analysis, including fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), were also reviewed. Glasgow Coma Scale (GCS), Hunt-Hess (HH) grade, and Fisher scale at the time of admission, and functional outcome by using modified Rankin Scale (mRS) at 6mo were compared. RESULTS: Of the 31 patients, 10 patients (32.3%) were diagnosed with Terson syndrome. All the patients with Terson syndrome did not report visual symptoms at the time of ophthalmologic screening. FA showed microvascular changes of retinal capillaries and varying degrees of disc leakage. SD-OCT allowed intuitive anatomical localization of multi-layered retinal hemorrhages and assessment of ellipsoid zone integrity. The patients with Terson syndrome showed significantly worse GCS (P=0.047) and HH grade (P=0.025) than those without, except Ficher scale (P=0.385). There was no significant difference in the mRS (P=0.250) at 6mo. Among baseline factors, the HH grade was the only significant factor associated with Terson syndrome (B=1.079, P=0.016). CONCLUSION: In our study, 32.3% of the patients have Terson syndrome without visual symptoms. The baseline HH grade is significantly correlated with Terson syndrome, and there is no significant difference in the functional outcome between the patients with and without Terson syndrome. Terson syndrome may develop without any visual symptoms as shown in our study, and ophthalmologic screening may be recommended to prevent further visual deterioration especially in the patients with poor HH grade at the time of aneurysmal SAH.

15 Association of candidate gene polymorphisms with diabetic retinopathy in Chinese patients with type 2 diabetes

Wen-Ying Fan , Hong Gu , Xiu-Fen Yang , Chong-Yang She , Xi-Pu Liu , Ning-Pu Liu

2020, 13(2):301-308. DOI: 10.18240/ijo.2020.02.15

[Abstract](1400) [HTML](0) [PDF 505.45 K](672)

Abstract:
AIM: To investigate the association between a set of six candidate genes and the risk of diabetic retinopathy (DR) in an urban community cohort of Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: A population-based cross-sectional study. The diabetic subjects were recruited from an urban community in Beijing and categorized into groups of proliferative diabetic retinopathy (PDR), non-proliferative diabetic retinopathy (NPDR), or diabetic without any retinopathy (DWR) based on the fundus photography and duration of diabetes. Six candidate genes, including advanced glycation end product specific receptor (AGER), aldose reductase (AKR1B1), inducible nitric oxide synthase (iNOS), pigment epithelium derived factor (PEDF), tumor necrosis factor-alpha (TNF-α), and paraoxonase 1 (PON1), were chosen based on Meta-analysis of genetic association studies for DR and biochemical pathways implicated in DR progression. The allele and genotype distribution of 21 functional single-nucleotide polymorphisms (SNPs) in those 6 candidate genes were investigated using MassARRAY genotyping system. RESULTS: Among 1461 diabetic patients recruited from community, 569 were selected in following genotyping analysis, including 97 patients with PDR, 217 with NPDR, and 255 with DWR. For the promoter variant rs1051993 in AGER gene, the distribution of allele and genotype in PDR group differed from that in DWR group (allele: P=0.011; genotype: P=0.01). Compared with DWR, patients with PDR had lower frequencies of heterozygous genotype GT (9.8% for DWR, 1% for PDR, OR: 0.10, 95%CI: 0.01-0.72) and minor allele T (4.9% for DWR, 0.5% for PDR, OR: 0.10, 95%CI: 0.01-0.75). In multivariate model, the distribution of genotype for rs1051993 in PDR group was significantly different from that in DWR group (GT vs GG: OR: 0.07, 95%CI: 0.01-0.61, P<0.001). No association with DR was observed in other genotyped SNPs. CONCLUSION: The data suggest a significant association of the promoter variant rs1051993 in AGER gene with PDR in Chinese cohort with T2DM.

16 Associations between near work, outdoor activity, parental myopia and myopia among school children in Aba, Nigeria

Uchenna Chigozirim Atowa , Samuel Otabor Wajuihian , Alvin Jeffery Munsamy

2020, 13(2):309-316. DOI: 10.18240/ijo.2020.02.16

[Abstract](1684) [HTML](0) [PDF 435.55 K](713)

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AIM: To assess the influence of near work, time outdoor and parental myopia on the prevalence of myopia in school children in Aba, Nigeria. METHODS: Primary and secondary school children aged between 8 and 15y were randomly recruited from 12 schools in Aba. Information on family history, near work and outdoor activity was obtained using myopia risk factor questionnaire. Cycloplegic refraction was performed using autorefraction technique. Myopia was defined as spherical equivalent refraction (SER) ≤-0.50 D in the poorer eye. Data were analysed for 1197 (male: 538 and female: 659) children with full relevant data. RESULTS: Risk of developing myopia was positively associated with parental myopia [odds ratio (OR): 6.80; 95%CI, 2.76-16.74; P<0.01) for one myopic parent and (OR: 9.47; 95%CI, 3.88-23.13; P<0.01) for two myopic parents, longer daily reading hour (OR: 1.21; 95%CI, 1.03-1.42; P=0.02) and less time outdoors (OR: 0.8; 95%CI, 0.74-0.87; P<0.01). CONCLUSION: Parental history of myopia is the most important risk factor associated with myopia. In addition, children with both parents being myopic has increased odds of developing myopia than those with one myopic parent. It is recommended therefore, that children spend more time outdoors as this could reduce the prevalence and progression of myopia.

17 Systematic review and Meta-analysis of treating open angle glaucoma with gonioscopy-assisted transluminal trabeculotomy

Chun-Yan Guo , Xiao-Hui Qi , Jian-Ming Qi

2020, 13(2):317-324. DOI: 10.18240/ijo.2020.02.17

[Abstract](1414) [HTML](0) [PDF 1.45 M](757)

Abstract:
AIM: To systematically review and Meta-analyze studies of managing open angle glaucoma (OAG) with gonioscopy-assisted transluminal trabeculotomy (GATT) and to evaluate its effectiveness and safety. METHODS: Eligible studies were retrieved and screened from five main electronic databases. Mean difference (MD) was hired to show the pooled effectiveness of intraocular pressure (IOP) and medication decrease achieved by GATT. In addition, combined surgical success and reoperation rates were calculated, and complications were also summarized. RESULTS: Ten studies were included for systematic review, but one study was not pooled for Meta-analysis due to the repeated data. The combined IOP decrease after GATT was 9.81 mm Hg (95%CI: 7.98-11.63 mm Hg) which showed significant reduction from the baselines (Z=10.52, P<0.0001). Similarly, the number of medications after GATT also decreased distinctly compared with that of medication before the surgery (Z=9.09, P<0.0001), and the pooled medication decrease was 1.68 (95%CI: 1.31-2.04). In addition, the combined surgical success rate was 85%, while the pooled reoperation rate was 20%. Sight-threatening complications occurred scarcely, whereas the pooled occurrence rate of hyphemia was as high as 36.0%. CONCLUSION: GATT could effectively lower IOP and decrease medications for patients with OAG. Moreover, the procedure appears to be a safe and promising treatment for OAG due to its minimally-invasive and conjunctiva-sparing nature.

18 Biomarkers in retinoblastoma

Jie Sun , Hui-Yu Xi , Qing Shao , Qing-Huai Liu

2020, 13(2):325-341. DOI: 10.18240/ijo.2020.02.18

[Abstract](1972) [HTML](0) [PDF 955.17 K](924)

Abstract:
Retinoblastoma (RB) is the most common intraocular malignancy of childhood caused by inactivation of the Rb genes. The prognosis of RB is better with an earlier diagnosis. Many diagnostic approaches and appropriate clinical treatments have been developed to improve clinical outcomes. However, limitations exist when utilizing current methods. Recently, many studies have identified identify new RB biomarkers which can be used in diagnosis, as prognostic indicators and may contribute to understanding the pathogenesis of RB and help determine specific treatment strategies. This review focuses on recent advances in the discovery of RB biomarkers and discusses their clinical utility and challenges from areas such as epigenetics, proteomics and radiogenomics.

19 Modified thin manual Descemet stripping endothelial keratoplasty with air-guided, non-pachymetric donor lenticule dissection: outcomes of graft thickness and complication rate

Abdo Karim Tourkmani , Andrew M J Turnbull , Parwez N Hossain , Aristides Konstantopoulos , David F Anderson

2020, 13(2):342-345. DOI: 10.18240/ijo.2020.02.19

[Abstract](891) [HTML](0) [PDF 482.18 K](614)

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AIM: To describe a modified technique of donor lenticule dissection for thin manual Descemet stripping endothelial keratoplasty (TM-DSEK). METHODS: Donor material was soaked in balanced salt solution (BSS) for 30min, before being mounted on an artificial anterior chamber (AAC). Rather than BSS, the AAC was filled with filtered air, resulting in a visible reflection at the corneal endothelium-air interface. This reflection served as a landmark for the depth of the dissection, facilitating the creation of a thin lenticule with low risk of perforation. Dissection was commenced at a standardized depth of 500 microns, with no initial pachymetry necessary. Totally 29 donor corneas were dissected by a novice TM-DSEK surgeon. Dissection time, central graft thickness at 2mo and complications were analysed. RESULTS: Results were similar to other endothelial keratoplasty techniques, despite the cases being performed by a novice DSEK surgeon. Mean dissection time was 7min (range 6-10). One graft perforation occurred (3.45%), but the air tamponaded the break and enabled dissection to be restarted and completed from a different location. Mean central graft thickness after at least two months follow-up was 106 microns (range 25-170). CONCLUSION: A problem with manual DSEK is the risk of graft perforation by attempting to dissect too thin a lenticule, or creating a thick graft due to fear of perforating. This modified air-guided technique addresses this problem, and is recommended for surgeons either embarking on the learning curve, or who wish to achieve more consistently thin grafts while reducing perforation rates.

20 A modified method for suprachoroidal fluid drainage in kissing choroidal detachment

Zi-Zhong Hu , Qing-Huai Liu , Yu-Zhi Ding , Yun Su , Jiang-Dong Ji

2020, 13(2):346-348. DOI: 10.18240/ijo.2020.02.20

[Abstract](1009) [HTML](0) [PDF 793.99 K](664)

Abstract:
AIM: To introduce a new method for suprachoroidal fluid drainage before 23-gauge pars plana vitrectomy. METHODS: A 15o side-port blade was firstly used to create a sclerotomy into the suprachoroidal space for initial drainage. A 30-guage needle was then applied to inject balanced saline solution through the existing sclerotomy for further drainage. After most of the suprachoroidal fluid was drained, standard 3-port 23-guage pars plana vitrectomy was performed. RESULTS: We have succeeded in using this technique to treat five patients with retinal detachment and kissing choroidal detachment (KCD). The choroidal detachment was visibly recessed in all cases after drainage with no intraoperative complications. After removal of silicon oil at 3mo follow-up, all patients obtained a reattached retina. No postoperative complications such as hypotony and endophthalmitis occurred. CONCLUSION: The new technique is efficient and safe for suprachoroidal fluid drainage for patients with rhegmatogenous retinal detachment. In future, further larger series are needed to attest to its safety and ef?cacy.

21 Diagnosis and surgical management of isolated inferior oblique palsy

Xiao-Fei Wu , Jian-Hua Yan

2020, 13(2):349-355. DOI: 10.18240/ijo.2020.02.21

[Abstract](1560) [HTML](0) [PDF 921.90 K](763)

Abstract:
AIM: To describe the etiology, clinical characteristics, surgical options and surgical outcomes of isolated inferior oblique palsy (IOP). METHODS: A retrospective review was performed on patients with isolated IOP who were seen between January 2010 and June 2017. The following clinical data were obtained from the patients’ charts: visual acuity, ocular alignment, ocular motility, cyclotorsion, stereoacuity, Parks three-step test, surgical methods, surgical outcomes and complications. Surgical success was defined as horizontal deviation ≤10 prism diopters (PD) and a vertical deviation ≤5 PD in primary gaze at both near and distant vision as assessed at last follow-up. RESULTS: The records from a total of 18 patients (8 males and 10 females) with an average age of 27.56y were included in this study. The right eye was affected in 11 patients, the left in 6 patients and both eyes in 1 patient. Twelve cases (66.7%) were congenital and 6 (33.3%) were acquired IOP. The 6 acquired cases involved 2 resulting from orbital trauma/surgery, 2 from midbrain microvascular ischemia, 1 from myasthenia gravis and 1 of unknown etiology. Strabismus surgery was performed in 13 cases. Surgical techniques included weakening of superior oblique and vertical rectus recession and resection. After a mean follow-up of 15.11mo, the corrected vertical deviation in primary position was 19.92±8.52 PD (P=0.000) and the corrected horizontal deviation was 14.31±12.68 PD (P=0.002). The surgical success rate was 61.5% and no surgical complications were present. CONCLUSION: Isolated IOP represents a rare condition, with most cases (66.7%) involving a congenital basis. The acquired cases included vascular, orbital trauma/surgery and myasthenia gravis. Weakening of the ipsilateral superior oblique muscle and/or contralateral superior rectus recession often resulted in favorable surgical outcomes with a surgical success rate of 61.5%.

22 Complications of intrastromal bevacizumab injection in lamellar keratoplasty

Mohammad Soleimani , Ahad Shahbazi , Nader Mohammadi , Seyed Ali Tabatabaei

2020, 13(2):356-358. DOI: 10.18240/ijo.2020.02.22

[Abstract](800) [HTML](0) [PDF 977.39 K](566)

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23 Formation of choroidal neovascularization under macular fovea after high-power laser irradiation: a case report

Shan-Shan Li , Xiao-Ran Chu , Fang Chen

2020, 13(2):359-361. DOI: 10.18240/ijo.2020.02.23

[Abstract](845) [HTML](0) [PDF 931.61 K](880)

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24 Comment on “Intravitreal conbercept injection for neovascular age-related macular degeneration”

Dan Călugăru , Mihai Călugăru

2020, 13(2):362-364. DOI: 10.18240/ijo.2020.02.24

[Abstract](969) [HTML](0) [PDF 604.58 K](614)

Abstract:

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Volume 13,Issue 2,2020 Table of Contents