Volume 14,Issue 2,2021 Table of Contents

1 Therapeutic effect of secretome from TNF-α stimulated mesenchymal stem cells in an experimental model of corneal limbal stem cell deficiency

Guo-Hu Di , Xia Qi , Jing Xu , Chao-Qun Yu , Qi-Long Cao , Zhi-Jun Xing , Zhi-Chao Li

2021, 14(2):179-185. DOI: 10.18240/ijo.2021.02.01

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Abstract:
AIM: To explore the secretome efficacy in tumor necrosis factor (TNF)-α stimulated mouse mesenchymal stem cells (MSCs) in a murine model of corneal limbal alkali injury. METHODS: Corneal limbal stem cell deficiency (LSCD) was created in the eyes of male C57 mice. Concentrated conditioned medium from TNF-α stimulated MSCs (MSC-CMT) was applied topically for 4wk, with basal medium and conditioned medium from MSCs as controls. Corneal opacification, corneal inflammatory response, and corneal neovascularization (NV) were evaluated. Corneal epithelial cell apoptosis, corneal conjunctivation, and inflammatory cell infiltration were assessed with TUNEL staining, CK3 and Muc-5AC immunostaining, and CD11b immunofluorescence staining, respectively. The effect of TSG-6 was further evaluated by knockdown with short hairpin RNA (shRNA). RESULTS: Compared to the controls, topical administration of MSC-CMT significantly ameliorated the clinical symptoms of alkali-induced LSCD, with restrained corneal NV, reduced corneal epithelial cell apoptosis, and inhibition of corneal conjunctivation. In addition, MSC-CMT treatment significantly reduced CD11b+ inflammatory cell infiltration, and inhibited the expression of pro-inflammatory cytokines (IL-1β, TNF-α and IL-6). Furthermore, the promotion of corneal epithelial reconstruction by MSC-CMT was largely abolished by TSG-6 knockdown. CONCLUSION: Our study provides evidence that MSC-CMT enhances the alleviation of corneal alkali injuries, partially through TSG-6-mediated anti-inflammatory protective mechanisms. MSC-CMT may serve as a potential strategy for treating corneal disorders.

2 Effect of luteolin on apoptosis and vascular endothelial growth factor in human choroidal melanoma cells

Meng-Lin Shi , Yu-Fen Chen , Hong-Fei Liao

2021, 14(2):186-193. DOI: 10.18240/ijo.2021.02.02

[Abstract](1173) [HTML](0) [PDF 2.49 M](774)

Abstract:
AIM: To investigate the effects of luteolin on apoptosis, the cell cycle, and the expression and secretion of vascular endothelial growth factor (VEGF) in human choroidal melanoma cells (C918 and OCM-1). METHODS: C918 and OCM-1 cells cultured in vitro were treated with various concentrations of luteolin (0, 5, 10, 15 μmol/L). Cell growth was observed with an inverted microscope, and cell cycle arrest was detected by propidium iodide (PI) staining using flow cytometry. Apoptosis was detected by Hoechst33342 staining, and apoptosis rate was determined by Annexin V-FITC/PI experiments using flow cytometry. The expression of apoptosis-related proteins Bcl-2, Bax and VEGF was analyzed using Western blots. The levels of VEGF secreted by the cells into the supernatant was analyzed using ELISA. RESULTS: After treating with 5 to 15 μmol/L luteolin for 48h, the fusion degree of C918 and OCM-1 cells decreased, and more floating apoptotic cells appeared. Luteolin treatment increased the G0-G1 phase ratio of the C918 and OCM-1 cells, blocked cell cycle progression, and increased the apoptosis rate of the C918 and OCM-1 cells. Western blot showed that luteolin decreased the expression of Bcl-2 and VEGF in the C918 and OCM-1 cells and increased the expression of Bax protein. The ELISA results showed that 10 to 15 μmol/L luteolin decreased the cell secretion of VEGF. CONCLUSION: Luteolin may induce apoptosis by regulating the levels of apoptosis-related proteins in C918 and OCM-1 cells. Luteolin can induce cell cycle arrest, decrease the expression of VEGF.

3 Protective effects of human umbilical cord mesenchymal stem cells on retinal ganglion cells in mice with acute ocular hypertension

Rui Liu , Qi Shi , Hong Yang , Xiao-Yuan Sha , Guo-Cheng Yu , Lian Liu , Jing-Xiang Zhong

2021, 14(2):194-199. DOI: 10.18240/ijo.2021.02.03

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Abstract:
AIM: To observe the protective effect of human umbilical cord mesenchymal stem cells (hucMSCs) on retinal ganglion cells (RGCs) injury in mice with acute ocular hypertension (AOH). METHODS: Fifty-six adult male C57BL/6 mice were randomly divided into four groups: normal group, AOH group, hucMSCs group, normal saline (NS) group. Left eye of mice was induced by 90 mm Hg intraocular pressure for 1h to establish AOH model. hucMSCs 1×105/μL, 1 μL or NS 1 μL was injected into the vitreous body the next day. CM-Dil fluorescent dye was used to label the 3rd generation of hucMSCs, for tracing the cells in the vitreous cavity of mice. Seven days after the model established, hematoxylin-eosin (HE) staining was used to observe the thickness of the inner retina layer in four groups. Numbers and loss rate of RGCs were evaluated by counting Brn-3a positive cells stained by immunofluorescencein. RESULTS: On the 7th day after AOH established, labeled hucMSCs were found in the vitreous cavity. HE staining showed that the thickness of retinal inner layer in AOH group was significantly lower than that in normal group and hucMSCs group (P<0.05), same as that in NS group (P>0.05). Compared with AOH group, the RGCs in normal group was significantly higher; RGCs number increased in hucMSCs group and the loss rate was lower (P<0.05). Injection of NS had no protective effect on RGCs. CONCLUSION: In AOH mouse model, vitreous injection of hucMSCs have shown a protection for RGCs.

4 Is Iba-1 protein expression a sensitive marker for microglia activation in experimental diabetic retinopathy?

Fan-Jun Shi , Hai Xie , Chao-Yang Zhang , Hai-Feng Qin , Xin-Wei Zeng , Hui Lou , Lei Zhang , Guo-Tong Xu , Jing-Fa Zhang , Guo-Xu Xu

2021, 14(2):200-208. DOI: 10.18240/ijo.2021.02.04

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Abstract:
AIM: To investigate the changes of Iba-1 and other potential markers for microglia activation in experimental diabetic retinopathy (DR). METHODS: Male Sprague-Dawley rats were rendered diabetes via intraperitoneal injection of streptozotocin. The retinas were harvested at 1 to 24wk after diabetes onset. Hypoxia-treated mouse microglial cell line (BV2 cells) was employed as the in vitro model to mimic diabetic condition. The expressions of Iba-1, CD11b, ICAM-1 as well as the inflammatory factors were examined with real-time polymerase chain reaction, Western blot and immunofluorescence both in vivo and in vitro. RESULTS: Compared with age-matched normal control, the number of microglia (Iba-1 positive immunostaining) in diabetic rat retinas was increased from 1 to 24wk of diabetes, which was most obvious at 12wk of diabetes. Iba-1 protein expression detected by Western blot was increased slightly in diabetic rat retinas compared with that in age-matched normal control; however, there was statistically significant between two groups only at 2wk after diabetes onset. The mRNA expression of Iba-1 was decreased significantly at 2 and 4wk of diabetic rat retinas, and remained unchanged at 8 and 12wk of diabetes. In BV2 cells, there was no significant change for the Iba-1 protein expression between normoxia and hypoxia groups; however, its mRNA level was decreased significantly under hypoxia. To further characterize microglial activation, F4/80, CD11b and inflammatory factors were detected both in vivo and in vitro. Compared with normal control, the expressions of F4/80 and CD11b as well as the inflammatory factors, such as ICAM-1, iNOS, COX2, IL-1β and IL-6, were increased significantly both in vivo and in vitro. CONCLUSION: Iba-1 protein expression might not be a sensitive marker to evaluate the activation of microglia in experimental DR. However, Iba-1 immunostaining, in combination with other markers like CD11b and ICAM-1, could be well reflect the activation of microglia. Thus, it is of great importance to explore other potential marker to evaluate the activation of microglia.

5 Retrobulbar administration of purified anti-nerve growth factor in developing rats induces structural and biochemical changes in the retina and cornea

Luigi Aloe , Maria Luisa Rocco , Bijorn Omar Balzamino , Graziana Esposito , Alessandra Micera

2021, 14(2):209-216. DOI: 10.18240/ijo.2021.02.05

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Abstract:
AIM: To develop an experimental model of endogenous nerve growth factor (NGF) deprivation by retrobulbar administration of purified neutralizing anti-NGF antibodies in young Sprague-Dawley rats and provide further information on NGF expression in the retina and cornea. METHODS: Sixty old pathogen-free Sprague Dawley rats (p14, post-natal days) were treated with repeated retrobulbar injections of neutralizing anti-NGF (2 μL, 100 μg/mL, every 3d). After 2wk (p28), retinal and corneal tissues were investigated for morphological, biochemical, and molecular expression of trkANGFR by using Western blotting or immunofluorescence. Rhodopsin as well as protein profile expression were also investigated. RESULTS: Chronic retrobulbar neutralizing anti-NGF antibodies changed the distribution of trkANGFR immunoreactivity at retinal level, while no changes were detected for global trkANGFR protein expression. By contrary, the treatment resulted in the increase of corneal trkANGFR expression. Retinal tissues showed a decreased rhodopsin expression as well as reduced number of both rhodopsin expressing and total retinal cells, as observed after single cell extraction. A decreased expression of ICAM-1, IL-17 and IL-13 as well as an increased expression of IL-21 typified retinal extracts. No significant changes were observed for corneal tissues. CONCLUSION: The reduced availability of endogenous NGF, as produced by chronic retrobulbar anti-NGF administration, produce a quick response from retinal tissues, with respect to corneal ones, suggesting the presence of early compensatory mechanisms to protect retinal networking.

6 Surgical correction of recurrent epiblepharon in Chinese children using modified skin re-draping epicanthoplasty

Shou-Long Hu , Wen-Qing Shi , Ting Su , Qian-Min Ge , Qiu-Yu Li , Biao Li , Rong-Bin Liang , Pei-Wen Zhu , Yi Shao

2021, 14(2):217-222. DOI: 10.18240/ijo.2021.02.06

[Abstract](1008) [HTML](0) [PDF 841.29 K](689)

Abstract:
AIM: To evaluate the clinical efficacy of the modified skin re-draping epicanthoplasty procedure for correction of recurrent lower lid epiblepharon in Chinese children. METHODS: From 2016 to 2018, 18 children (10 males and 8 females, average age 6.2±1.7y; 30 eyes) with recurrent epiblepharon who attended Beijing Children’s Hospital were included in the study. All the children had undergone lower eyelid surgery for epiblepharon. Surgical design included using an additional incision along the upper palpebral margin, to avoid vertical scarring on the upper lid. The re-draping method was used to correct recurrent epiblepharon. Follow-up ranged from 3 to 24mo. Postoperative surgical outcomes, complications, and subjective satisfaction were evaluated. RESULTS: Complete correction of cilia touching the cornea was observed in all patients during an average follow-up of 7.1mo. No “dog ears” or obvious scars were formed after surgery. All parents were satisfied with the cosmetic results and none complained. Mean astigmatism decreased from 2.39±0.79 diopter (D) preoperatively to 2.19±0.79 D at 6mo after surgery; however, the difference was not significant. Best-corrected visual acuity improved, although the change in mean visual acuity was not significant. No recurrence occurred during the follow-up period. CONCLUSION: This surgical modified skin re-draping technique is effective and highly satisfactory for correction of recurrent epiblepharon. The approach is characterized by a simple design, a straightforward procedure, inconspicuous scarring, and good postoperative appearance.

7 Expression and role of specificity protein 1 and collagen I in recurrent pterygial tissues

Chun-Sheng Shi , Yue Wu , Na Shu , Li-Li Jiang , Bo Jiang

2021, 14(2):223-227. DOI: 10.18240/ijo.2021.02.07

[Abstract](992) [HTML](0) [PDF 525.07 K](587)

Abstract:
AIM: To investigate the expression profiles of the transcription factor specificity protein 1 (Sp1) and collagen I in recurrent pterygial tissues. What is more, to compare the changes of Sp1 and collagen I among primary pterygial tissue, recurrent pterygial tissue and conjunctival tissue. METHODS: In the prospective study, we collected the pterygial tissues of 40 patients who underwent resection of primary pterygial tissue and recurrent pterygial tissue, and the conjunctival tissues of 10 patients with enucleation due to trauma. The relative expression levels of Sp1 and collagen I were analyzed by reverse transcription quantitative-polymerase chain reaction and Western blot. Paired t-test was performed to compare the Sp1 and collagen I of recurrent pterygial tissues, as well as the primary pterygial tissues and conjunctival tissues. In further, Pearson’s hypothesis testing of correlation coefficients was used to compare the correlations of Sp1 and Collagen I. RESULTS: The content of Sp1 and collagen I mRNA and protein was significantly greater in recurrent pterygial tissue than that was in primary and conjunctival tissue (P<0.05). There was a positive correlation between the mRNA and protein levels of Sp1 and collagen I in recurrent pterygial tissues (protein: r=0.913, P<0.05; mRNA: r=0.945, P<0.05). CONCLUSION: Sp1 and collagen I are expressed in normal conjunctival, primary, and recurrent pterygial tissues, but expression is significantly greater in the latter. Sp1 and collagen I may be involved in the regulation of the development of recurrent pterygium.

8 Evaluation of corneal topographic, tomographic and biomechanical indices for detecting clinical and subclinical keratoconus: a comprehensive three-device study

Zahra Heidari , Hassan Hashemi , Mehrdad Mohammadpour , Kazem Amanzadeh , Akbar Fotouhi

2021, 14(2):228-239. DOI: 10.18240/ijo.2021.02.08

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AIM: To evaluate the diagnostic ability of topographic and tomographic indices with Pentacam and Sirius as well as biomechanical parameters with Corvis ST for the detection of clinical and subclinical forms of keratoconus (KCN). METHODS: In this prospective diagnostic test study, 70 patients with clinical KCN, 79 patients with abnormal findings in topography and tomography maps with no evidence on clinical examination (subclinical KCN), and 68 normal control subjects were enrolled. The accuracy of topographic, tomographic, and biomechanical parameters was evaluated using the area under the receiver operating characteristic curve (AUC) and cross-validation analysis. The Delong method was used for comparing AUCs. RESULTS: In distinguishing KCN from normal, all parameters showed statistically significant differences between the two groups (P<0.001). Indices with the perfect diagnostic ability (AUC≥0.999) were Sirius KCN vertex of back (KVb), Pentacam random forest index (PRFI), Pentacam index of height decentration (IHD), and Corvis integrated tomographic/biomechanical index (TBI). In distinguishing subclinical KCN from normal, Sirius symmetry index of back (SIb; AUC=0.908), Pentacam inferior-superior difference (IS) value (AUC=0.862), PRFI (AUC=0.847), and Corvis TBI (AUC=0.820) performed best. There were no significant differences between the highest AUCs within keratoconic groups (DeLong, P>0.05). CONCLUSION: In clinical KCN, all topographic, tomographic, and biomechanical indices have acceptable outcomes in terms of sensitivity and specificity. However, in differentiating subclinical forms of KCN from normal corneas, curvature-based parameters (SIb and IS value) followed by integrated indices (PRFI and TBI) are the most powerful tools for early detection of KCN.

9 Ultrasound elastography for evaluating stiffness of the human lens nucleus with aging: a feasibility study

Hai-Yan Zhou , Hong Yan , Wei-Jia Yan , Xin-Chuan Wang

2021, 14(2):240-244. DOI: 10.18240/ijo.2021.02.09

[Abstract](823) [HTML](0) [PDF 1.72 M](586)

Abstract:
AIM: To investigate the significance of ultrasound elastography for evaluating stiffness of the human lens nucleus in volunteers with different ages. METHODS: A total of 90 volunteers (lens transparency, uncorrected visual acuity ≥0.5, intraocular pressure: 14-19 mm Hg) were divided into 3 groups according to age: Group A (30 people, median age: 82±3.5y, mean axial lengths 23.7±0.5 mm); Group B (30 people, median age: 46±2.1y, mean axial lengths 23.9±0.4 mm); and Group C (30 people, median age: 22±3.5y, mean axial lengths 24.0±0.4 mm). Lens nuclear stiffness was measured by Free-hand qualitative elastography by independent operators. Strain gray scale and color-coded elastography maps were recorded. In each case, three consecutive detections were performed and strain ratio was used for statistical analysis. RESULTS: Elastography analysis showed excellent diagnostic performance for lens sclerosis. Lens strain ratio was lowest (0.03±0.01)% in Group A and highest (2.03±0.43)% in Group C. Lens strain ratio was moderate (0.64±0.10)% in Group B. There were significant differences between these three groups (P<0.05). The lens nucleus strain rate changes with age. With aging, the lens nucleus strain rate and resilience decrease, demonstrating harder texture. CONCLUSION: The relationship between human lens stiffness and age is demonstrated by ultrasound elastography. Older age is associated with lower strain ratio and less resilience of the lens.

10 Objective visual quality one year after toric IOL implantation for correction of moderate and high corneal astigmatism

Hui Zhong , Hong Qin , Hui-Juan Wang , Zhao-Yi Wang

2021, 14(2):245-249. DOI: 10.18240/ijo.2021.02.10

[Abstract](982) [HTML](0) [PDF 393.15 K](544)

Abstract:
AIM: To compare the objective visual quality after implantation of a toric intraocular lens (IOL) in order to correct moderate or high corneal astigmatism at the one year postoperative follow-up. METHODS: From December 2017 to June 2018, 66 patients (90 eyes) with simple age-related cataract with regular corneal astigmatism greater than 1.5 D were enrolled in this prospective self-control study. The patients were implanted with Proming® toric IOL (model: AT3BH-AT6BH). The subjects were divided into moderate astigmatism group (46 eyes, 1.5-2.5 D) and high astigmatism group (44 eyes, >2.5 D). The uncorrected distance visual acuity, residual astigmatism and axial position of IOL were observed before operation, 3, 6mo and 1y after operation. Modulation transfer function cutoff (MTF cutoff), Strehl ratio (SR), object scatter index (OSI) were observed by OQAS II to evaluate the objective visual quality of patients. RESULTS: There was no significant difference in UCVA, residual astigmatism, axial deviation, MTF cutoff, SR and OSI between moderate and high astigmatism group (all P>0.05). After 3mo, UCVA, MTF cutoff and SR were significantly increased (all P<0.05), residual astigmatism and OSI were significantly decreased (all P<0.05). After 3mo, all the indexes remained stable. CONCLUSION: Proming toric IOL can effectively treat age-related cataract patients with moderate-to-high regular corneal astigmatism, correcting corneal astigmatism, improving UCVA, ensuring long-term stability in the capsule, and providing patients with better visual quality.

11 Refractive outcomes after vitrectomy combined with phacoemulsification of idiopathic macular holes

Bo-Shi Liu , Wei-Na Cui , Rui Niu , Qiong Chen , Ze-Tong Nie , Jiao-Ting Wei , Bo-Jie Hu

2021, 14(2):250-254. DOI: 10.18240/ijo.2021.02.11

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AIM: To report the refractive outcomes after vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation (phaco-vitrectomy) in idiopathic macular holes (IMH). METHODS: A total of 56 eyes with IMH (IMH group) that underwent phaco-vitrectomy and 44 eyes with age-related cataract (ARC group) that underwent cataract surgery were retrospectively reviewed. The best corrective visual acuity (BCVA), predicted refractive error (PRE), actual refractive error (ARE), axial length (AL), were measured in both groups before and 6mo after operation. The power calculation of IOL and the predicted refractive error (PRE) were calculated according to the SRK/T formula. The difference of PRE and ARE between the two groups were compared and analyzed. RESULTS: In the IMH group, the diameters of macular holes were 271.73±75.85 μm, the closure rate was 100%. The pre- and post-operative BCVA were 0.80±0.35 and 0.40±0.35 logMAR. The PRE of A-ultrasound and IOL Master in the IMH group was -0.27±0.25 and 0.10±0.66 D. The postoperative mean absolute prediction error (MAE) was observed to be 0.58±0.65 and 0.53±0.37 D in the IOL Master and A-ultrasound (P=0.758). The PRE and ARE of the IMH group were 0.10±0.66 D and -0.19±0.64 D (P=0.102). The PRE and ARE of the ARC group was -0.43±0.95 and -0.31±0.93 D (P=0.383). The difference between PRE and ARE was -0.33±0.81 and 0.09±0.64 D in the IMH and ARC groups (P=0.021). The proportion of myopic shift was 67.9% in the IMH group and 27.3% in the ARC group (P=0.004). CONCLUSION: The myopic shift can be observed in patients with IMH after phaco-vitrectomy.

12 Association between risk factors and retinal nerve fiber layer loss in early stages of diabetic retinopathy

Zhong-Qi Wan , Yan Gao , Min Cui , Yong-Jie Zhang

2021, 14(2):255-262. DOI: 10.18240/ijo.2021.02.12

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Abstract:
AIM: To investigate the changes of retinal nerve fiber layer (RNFL) among normal individuals, diabetic patients without diabetic retinopathy (NDR) and non-proliferative diabetic retinopathy (NPDR), and explore the possible risk factors of early diabetic retinopathy (DR). METHODS: In this cross-sectional study, 107 participants were divided in three groups. Totally 31 normal individuals (control group), 40 diabetic patients without DR (NDR group) and 36 patients with NPDR (NPDR group) were included. Optical coherence tomography (OCT) was used to detect RNFL thickness and other optic disc parameters among different groups. The potential association between RNFL loss and systemic risk factors were assessed for DR, including diabetes duration, body mass index (BMI), hemoglobin A1c (HbA1c), serum lipids, and blood pressure. RESULTS: The average and each quadrant RNFL thickness were thinner in NPDR group compared to control group of the right (P=0.00, P=0.01, P=0.01, P=0.02, P=0.04) and left eyes (P=0.00, P=0.00, P=0.00, P=0.03, P=0.04). The average, superior and inferior RNFL thickness were thinner in NDR group compared to the NPDR group of the right (P=0.00, P=0.02, P=0.03) and left eyes (P=0.00, P=0.00, P=0.01). Diabetic duration was negatively correlated with the superior, inferior, and average RNFL thickness of the right (r=-0.385, P=0.001; r=-0.366, P=0.001; r=-0.503, P=0.000) and left eyes (r=-0.271, P=0.018; r=0.278, P=0.015; r=-0.260, P=0.023). HbA1c was negatively correlated with the superior, inferior, and average RNFL thickness of the right (r=-0.316 P=0.005; r=-0.414, P=0.000; r=-0.418, P=0.000) and left eyes (r= -0.367, P=0.001; r=-0.250, P=0.030; r=-0.393, P=0.000). Systolic pressure was negatively correlated with the inferior and average RNFL thickness of the right eye (r=-0.402, P=0.000; r=-0.371, P=0.001) and was negatively correlated with the superior and average RNFL thickness of the left eye (r=-0.264, P=0.021; r=-0.233, P=0.043). CONCLUSION: RNFL loss, especially in the superior and inferior quadrants, may be the earliest structural change of the retina in diabetic patients, and is also associated with diabetic duration, HbA1c, and systolic pressure.

13 A pilot study on vitrectomy combined with scleral shortening for eyes with myopic macular retinoschisis—2y follow-up results

Peng Zhang , Cun-Xi Ye , Ling-Xin Hou , Yu-Hua Hao , Kun Wang , Qing-Li Shang

2021, 14(2):263-268. DOI: 10.18240/ijo.2021.02.13

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Abstract:
AIM: To evaluate the effect of vitrectomy combined with scleral shortening for eyes with myopic macular retinoschisis. METHODS: Thirty-seven patients with myopic macular retinoschisis who underwent pars plana vitrectomy (PPV) combined with scleral shortening were reviewed. Axial length (AL), the height of macular retinoschisis, the height of retinal detachment if existed, the diameter of macular hole if existed and best corrected visual acuity (BCVA) were obtained. The preoperative and postoperative parameters were compared. RESULTS: At postoperative 24mo, the mean AL and height of macular retinoschisis were reduced significantly by 0.79 mm and 256.51 μm (t=8.064, P<0.0001; Z=-5.086, P<0.0001) respectively. In addition, the mean height of retinal detachment and diameter of macular hole were also reduced significantly by 365.38 μm and 183.68 μm (Z=-4.457, P=0.000008; Z=-2.983, P=0.003) respectively. Meanwhile, the postoperative BCVA was improved markedly (Z=-2.126, P=0.033). CONCLUSION: Vitrectomy combined with scleral shortening is an effective surgical method for eyes with myopic macular retinoschisis, whether or not macular hole and retinal detachment are present.

14 Diabetes onset at an earlier age and high HbA1c levels as risk factors of diabetic retinopathy

Rui-Fang Feng , Hai-Yang Liu , Ya-Lu Liu , Qing Xu , Lei Qiao , Chao-Ju Gong , Yi-Peng Zhang , Jie Li , Li-Na Guan , Wei Fan , Mei-Li Li , Wen-Jin Li , Su-Yan Li

2021, 14(2):269-276. DOI: 10.18240/ijo.2021.02.14

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Abstract:
AIM: To assess the effect of age at diabetes onset and uncontrollable high HbA1c levels on the development of diabetic retinopathy (DR) among Chinese type 2 diabetes mellitus (DM) patients. METHODS: This was a cross-sectional survey of diabetic patients in Subei district, China. Data covering physical measurements, fasting blood-glucose (FBG), glycosylated hemoglobin (HbA1c), blood lipid, urinary albumin/creatinine ratio (UACR), ocular fundus examination, and diabetes treatment records were collected. An independent sample t-test were used to analyze differences. A Logistic regression analysis was applied to study the independent risk factors of DR. RESULTS: A total of 1282 patients with type 2 DM were enrolled, and 191 cases had DR (14.9%). The age at diabetes onset, education level, alcohol consumption, HbA1c level, UACR level, and hypoglycemic drugs were independent influencing factors for DR. The older the onset of diabetes, the less likely to develop DR (OR: 0.958, 95%CI: 0.942-0.975, P=0.000). Patients were then divided in terms of age at diabetes onset as follows: <50y, 50-59y, 60-69y, and ≥70y. Compared with diabetes onset age <50y, 50-59y (OR: 0.463, 95%CI: 0.306-0.699, P=0.000), 60-69y (OR: 0.329, 95%CI: 0.203-0.535, P=0.000) and ≥70y (OR: 0.232, 95%CI: 0.094-0.577, P=0.002) were at a lower risk of DR. The prevalence of DR was highest in patients with diabetes onset age <50y (29.5%, P<0.05). The HbA1c level (8.67±1.97)% and proportion of insulin injection (52.5%) in patients with diabetes onset <40y were higher than in patients with older diabetes onset age (P<0.05). CONCLUSION: Diabetes onset at an earlier age and uncontrollable high HbA1c level could be independent risk factors for DR.

15 Effects of diode laser photocoagulation treatment on ocular biometric parameters in premature infants with retinopathy of prematurity

Damla Erginturk Acar , Ugur Acar , Zuhal Ozen Tunay , Aysegul Arman , Anil Barak

2021, 14(2):277-282. DOI: 10.18240/ijo.2021.02.15

[Abstract](717) [HTML](0) [PDF 460.88 K](535)

Abstract:
AIM: To investigate the effects of diode laser treatment on ocular biometric parameters in premature infants with retinopathy of prematurity (ROP). METHODS: Premature infants who received diode laser treatment for ROP (n=68) and premature infants with spontaneous regressed ROP without treatment (n=50) were performed longitudinal ocular biometric measurements including anterior chamber depth, lens thickness and axial length as follows: 1d prior to laser treatment, and 3, 6, 9, and 12mo after the laser treatment. RESULTS: The mean birth weight, gestational age and initial examination time values were 936.53±302.07 g, 26.66±2.42wk, 36.26±2.73wk in the treatment group and 959.78±260.08 g, 27.28±2.10wk, 36.56±2.54wk in the control group. There was no statistically significant difference in these demographic characteristics of the groups. Anterior chamber depth, lens thickness and axial length demonstrated statistically significant linear increases during the study period in the two groups (P<0.001 for each). There were no statistically significant differences between the two groups in terms of anterior chamber depth after laser treatment. Measurements of the lens thickness at 9th and 12th months (9th month 3.70±0.22 vs 3.60±0.21 mm, P=0.017; 12th month 3.81±0.21 vs 3.69±0.22 mm, P=0.002) and the axial length at 12th month (19.35±0.79 vs 19.13±0.54 mm, P=0.031) after laser treatment were statistically higher in the treatment group. CONCLUSION: Diode laser retinal photocoagulation treatment in premature infants seems to increase the lens thickness and axial length.

16 Comparison of early changes in ocular surface markers and tear inflammatory mediators after femtosecond lenticule extraction and FS-LASIK

Chi Zhang , Hui Ding , Hong He , He Jin , Liang-Ping Liu , Xiao-Wei Yang , Jun Yang , Xing-Wu Zhong

2021, 14(2):283-291. DOI: 10.18240/ijo.2021.02.16

[Abstract](917) [HTML](0) [PDF 1.54 M](565)

Abstract:
AIM: To compare the short-term impacts of femtosecond lenticule extraction (FLEx) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) on ocular surface measures and tear inflammatory mediators. METHODS: This prospective comparative nonrandomized clinical study comprised 75 eyes (75 patients). Totally 20 male and 15 female patients (age 21.62±3.25y) with 35 eyes underwent FLEx, and 26 male and 14 female patients (age 20.18±3.59y) with 40 eyes underwent FS-LASIK. Central corneal sensitivity, noninvasive tear breakup time, corneal fluorescein staining, Schirmer I test, tear meniscus height, and ocular surface disease index were evaluated in all patients. Tear concentrations of nerve growth factor (NGF), interleukin-1α (IL-1α), transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and matrix metalloproteinase-9 (MMP-9) were assessed by multiplex antibody microarray. All measurements were performed preoperatively, and 1d, 1wk, and 1mo postoperatively. RESULTS: Patients who underwent FLEx exhibited a more moderate reduction in central corneal sensation and less corneal fluorescein staining than those in the FS-LASIK group 1wk after the procedure (P<0.01). NGF was significantly higher 1d and 1wk after surgery in the FS-LASIK group than in the FLEx group (P<0.01). By contrast, compared to those in the FLEx group, higher postoperative values and slower recovery of tear TGF-β1, IL-1α, and TNF-α concentrations were observed in the FS-LASIK group (P<0.01). Tear concentrations of NGF, TGF-β1, TNF-α, and IL-1α were correlated with ocular surface changes after FLEx or FS-LASIK surgery. CONCLUSION: There is less early ocular surface disruption and a reduced inflammatory response after FLEx than after FS-LASIK. NGF, TGF-β1, TNF-α, and IL-1α may contribute to the process of ocular surface recovery.

17 Effect of axial length and anterior chamber depth on the peripheral refraction profile

Masoud Khorrami-Nejad , Raha Moradi , Alireza Akbarzadeh Baghban , Bahram Khosravi

2021, 14(2):292-298. DOI: 10.18240/ijo.2021.02.17

[Abstract](1045) [HTML](0) [PDF 686.07 K](611)

Abstract:
AIM: To evaluate the effect of axial length (AL) and anterior chamber depth (ACD) on peripheral refractive profile in myopic patients compared to emmetropic participants. METHODS: This cross-sectional study was conducted in right eyes of 58 participants of whom 38 were emmetropic and 20 were myopic. Central and peripheral refraction were measured at 10°, 20°, and 30° eccentricities in nasal and temporal fields using an open-field autorefractor. The Lenstar LS900 was used to measure ACD and AL. The participants were divided into three groups of short (<22.5 mm), normal (22.5-24.5 mm), and long eye (>24.5 mm) according to AL and three groups of low ACD (<3.00 mm), normal ACD (3.00-3.60 mm), and high ACD (>3.60 mm) according to ACD. RESULTS: The mean age of the participants was 22.26±3.09y (range 18-30y). The peripheral mean spherical refractive error showed a hypermetropic shift in myopic and emmetropic groups although this shift was more pronounced in the myopic group. The results showed significant changes in the spherical equivalent, J0, and J45 astigmatism in all gazes with an increase in eccentricity (P<0.001). The pattern of refractive error changes was more noticeable in long and short eyes versus normal AL eyes. Moreover, the pattern of peripheral refractive changes was much more prominent in the high ACD group versus the normal ACD group and in the normal ACD group versus the low ACD group. CONCLUSION: Peripheral refraction changes are greater in participants with AL values outside the normal range and deeper ACD values compared to participants with normal AL and ACD.

18 Analysis of the etiologies, treatments and prognoses in children and adolescent vitreous hemorrhage

Zheng-Wei Liu , Jie Peng , Chun-Li Chen , Xue-Hao Cui , Pei-Quan Zhao

2021, 14(2):299-305. DOI: 10.18240/ijo.2021.02.18

[Abstract](1027) [HTML](0) [PDF 413.72 K](667)

Abstract:
AIM: To determine the etiologies, treatment modalities and visual outcomes of vitreous hemorrhage (VH; range from birth to 18y). METHODS: A total of 262 eyes from 210 patients between January 2010 and September 2016 were included. All children underwent an appropriate ocular and systemic examination. Data collected included demographics, clinical manifestations, details of the ocular and systemic examination, management details, final fundus anatomy and visual acuity (VA). RESULTS: The most common etiologies were non-traumatic VH (64.89%), most of which were due to retinopathy of prematurity (ROP; 37.10%); while traffic accidents, including 16 (21.00%) eyes, was the most common ocular traumas. Surgery, performed in 143 (54.58%) eyes, was the most common management modality. The initial mean baseline visual acuity was 2.77±0.21 logarithm of the minimal angle of resolution (logMAR) in children and adolescent with traumatic VH, which was significantly improved to 2.15±1.31 logMAR (P<0.05). CONCLUSION: VH in children and adolescent has a complicated and diverse etiology. ROP is the primary cause of non-traumatic VH, which is the most common etiology. Appropriate treatment of traumatic VH is associated with obvious improvement in visual acuity. The initial VA is one of most important predictors of outcome.

19 Current status of emergency treatment of chemical eye burns in workplaces

Kevin Claassen , Dominique Rodil Dos Anjos , Horst Christoph Broding

2021, 14(2):306-309. DOI: 10.18240/ijo.2021.02.19

[Abstract](1115) [HTML](0) [PDF 326.68 K](642)

Abstract:
Chemical eye burns present an avoidable, but frequent, occupational injury with potentially detrimental consequences for the quality of life and occupational rehabilitation of the injured. A periodical review of guidelines is required to assure the optimal emergency management. We reviewed the literature with emphasis on current German guidelines, primarily MEDLINE. If the crucial first-line measure, the injury prevention has failed and an eye burn has been sustained, the immediate and copious rinsing of the eye is the pivotal emergency treatment modality. Whereas the immediacy and sufficiency of the emergency rinsing are largely unanimous, there is an ongoing debate about the benefits and risks of specific rinsing solutions, and regular updates on guidelines and recommendations for the emergency treatment are warranted. The easiest and readily available rinsing solution is tap water, which fulfils the crucial criteria conveniently in most industrialized countries: purity, sterility, and neutral pH. Other rinsing solutions are proposing higher osmolality to stabilize the physiological pH, because of their superior buffering capacity. However, there is no compelling evidence for a substantial benefit, and some reports suggest that there could be unwanted side effects. In combination with the substantially increased expenditure and a more complex handling procedure, currently a general recommendation of any other solution than tap water is not warranted.

20 Safety, effectiveness, and cost-effectiveness of Argus II in patients with retinitis pigmentosa: a systematic review

Zakieh Ostad-Ahmadi , Amin Daemi , Mohammad-Reza Modabberi , Ali Mostafaie

2021, 14(2):310-316. DOI: 10.18240/ijo.2021.02.20

[Abstract](1144) [HTML](0) [PDF 452.39 K](701)

Abstract:
AIM: To assess the effectiveness, safety, and cost-effectiveness of the Argus II in treatment of the retinitis pigmentosa (RP) patients. METHODS: The ProQuest, Web of Science, EMBASE, MEDLINE (via PubMed) were searched using combinations of the keywords of Argus, safety, effectiveness, bionic eye, retinal prosthesis, and RP through March 2018. The retrieved records were screened and then assessed for eligibility. RESULTS: Totally 926 records were retrieved from the searched databases and finally 12 studies included. The RP patients showed improvements in visual function after receiving the prosthesis, compared to the time before the prosthesis or the time it was off. This was measured by square localization, direction of motion, and grating visual acuity tests. No major adverse effect was reported for the Argus II prosthesis itself and/or the surgery to implement it, but the most frequently reported items were hypotony, and conjunctival dehiscence. The incremental cost-effectiveness ratio (ICER) was calculated to be €14603 per quality-adjusted life year (QALY) in UK and $207 616 per QALY in Canada. CONCLUSION: The available evidence shows that the Argus II prosthesis in RP patients is effective in improvement of their visual function. Some minor adverse effects are reported for the prosthesis. The cost-effectiveness studies show that the technology is cost-effective only at high levels of willingness-to-pay.

21 Utilizing dexamethasone intravitreal implant to control postoperative inflammation in refractory uveitis undergoing cataract surgery

Yong-Tao Li , Xue-Xue Cui , Xiao-Tong Yang , Bing Li , Xin-Jun Ren , Xiao-Rong Li , Xiao-Min Zhang

2021, 14(2):317-322. DOI: 10.18240/ijo.2021.02.21

[Abstract](1089) [HTML](0) [PDF 1.05 M](646)

Abstract:
AIM: To report the effectiveness of intravitreal implantation of dexamethasone implant (Ozurdex) after phacoemulsification and intraocular lens implantation in refractory uveitis patients. METHODS: This single-center retrospective study conducted for refractory pan-uveitis patients who underwent cataract surgery combined with intravitreal Ozurdex implantation. The main outcome measurements were best-corrected visual acuity (BCVA), central retinal thickness (CRT), grade of anterior chamber cell (AAC), intraocular pressure (IOP), and systemic/ocular adverse events. RESULTS: Ten eyes of 7 patients were included. BCVA showed significant improvement at 1mo (P=0.004), 3mo (P=0.0004), and 6mo (P=0.001) post operation. There were no statistically significant differences in the postoperative CRT among follow-up groups (P>0.05). No significant differences were observed in the baseline IOP when compared to 1, 3, and 6mo (all P>0.05) post operation. One patient developed a transient elevated IOP post injection. Two eyes (20%) developed posterior capsular opacifications and underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy. In six patients (8 eyes, 71.4%), the systemic steroid usage was reduced to below 10 mg/d. The patients experienced a mean of 1.4±0.52 recurrences of inflammation in the 6mo before operation and 0.7±0.48 in the 6mon post operation. The mean recurrence time was 13±0.58wk (range 12-14wk) post operation. In five of seven patients (7 out of 10 eyes), inflammation relapse was developed postoperatively. Only one patient (2 eyes) needed increased amounts of oral corticosteroids. Intraocular inflammation recurrence in the remaining patients was controlled by topical steroids. CONCLUSION: Ozurdex is considered a safe and effective approach to control postoperative inflammation in cataract surgery for patients with refractory uveitis in our study. After the disappearance of Ozurdex’s anti-inflammatory effects over time, in most cases the recurrent inflammation can be controlled by topical steroids.

22 Exudative hemorrhagic retinopathy related to all-trans retinoic acid differentiation syndrome in a patient with acute promyelocytic leukemia

Emily K. Tam , Steven Ness , Crandall E. Peeler

2021, 14(2):323-325. DOI: 10.18240/ijo.2021.02.22

[Abstract](677) [HTML](0) [PDF 1.03 M](520)

Abstract:

23 Accelerated growth of uveal melanoma related to pregnancy: a case report and literature review

Han Yue , Jiang Qian , Hui Ren , Rui Zhang , Lu Gan , Ying-Wen Bi

2021, 14(2):326-329. DOI: 10.18240/ijo.2021.02.23

[Abstract](970) [HTML](0) [PDF 1.27 M](659)

Abstract:

24 Toric intraocular collamer lens with anterior chamber maintainer for myopic astigmatism following penetrating keratoplasty: a case report

Zong-Ming Zhuang , Hao-Yu Li , Shao-Jian Tan

2021, 14(2):330-332. DOI: 10.18240/ijo.2021.02.24

[Abstract](879) [HTML](0) [PDF 534.41 K](605)

Abstract:

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Volume 14,Issue 2,2021 Table of Contents