Volume 14,Issue 5,2021 Table of Contents

1 Ophthalmic practice during COVID-19 pandemic

Mohammad Soleimani , Mohammad Mehrpour , Hossein Mohammad-Rabei

2021, 14(5):639-642. DOI: 10.18240/ijo.2021.05.01

[Abstract](1340) [HTML](0) [PDF 316.69 K](716)

Abstract:
Coronavirus disease 2019 (COVID-19) pandemic has caused significant changes in ophthalmic practice. The initial strategy of strict restriction of elective activities has been replaced with various guidelines to revitalize ophthalmic procedures considering the new safety concerns. In this manuscript, we reviewed recent recommendations for ophthalmic practice in different fields of ophthalmology during the COVID-19 pandemic.

2 Role of microRNA-25 in high glucose cultured Müller glia

Yu Liu , Han Shen , Song-Tao Yuan , Qing-Huai Liu

2021, 14(5):643-648. DOI: 10.18240/ijo.2021.05.02

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AIM: To investigate the role of microRNA-25 (miR-25) in proliferation and apoptosis of retinal Müller glia (MG) under high glucose condition. METHODS: The purity of the cultured cells was verified by immunocytochemistry and flow cytometry using antibodies that specifically recognized MG. The expression level of miR-25 under normal and high glucose conditions were validated by quantitative reverse transcription polymerase chain reaction (RT-qPCR). miR-25 mimics and negative control were transfected into MG and multiple functional experiments including cell counting kit-8 assay, EDU assay, and flow cytometry were conducted to explore the effects of miR-25 on the proliferation and apoptosis of high glucose cultured MG (HGMG). RESULTS: Immunocytochemistry and flow cytometry confirmed the high purity of primary cultured MG. RT-PCR results showed that the expression level of miR-25 was significantly repressed in HGMG, while over-expression of miR-25 by miR-25 mimic markedly inhibited the high glucose induced cell apoptosis and promoted the proliferation of MG. CONCLUSION: The expression level of miR-25 is significantly downregulated in HGMG and its overexpression could attenuate the high glucose damages on MG by promoting proliferation and reducing apoptosis.

3 Protective effects of upregulated HO-1 gene against the apoptosis of human retinal pigment epithelial cells in vitro

Yu Hong , Yu-Ping Liang , Wei-Qi Chen , Liu-Xia You , Qing-Feng Ni , Xiu-Yun Gao , Xiao-Rong Lin

2021, 14(5):649-655. DOI: 10.18240/ijo.2021.05.03

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Abstract:
AIM: To investigate the protective effect of heme oxygenase-1 (HO-1) against H2O2-induced apoptosis in human ARPE-19 cells. METHODS: The lentiviral vector expressing HO-1 was prepared and transfected into apoptotic ARPE-19 cells induced by H2O2. Functional experiments including cell counting kit-8 (CCK-8) assay, flow cytometry (FCM) and mitochondrial membrane potential assay were conducted. RESULTS: The ultrastructure of ARPE-19 cells was observed using transmission electron microscope (TEM). It was found that exogenous HO-1 significantly ameliorated H2O2-induced loss of cell viability, apoptosis and intracellular levels of reactive oxygen species (ROS) in ARPE-19 cells. The overexpression of HO-1 facilitated the transfer of nuclear factor erythroid-2-related factor 2 (Nrf2) from cytoplasm to nucleus, which in turn upregualted expressions HO-1 and B-cell lymphoma-2 (Bcl-2). Furthermore, HO-1 upregulation further inhibited H2O2-induced release of cysteinyl aspartate specific proteinase-3 (caspase-3). CONCLUSION: Exogenous HO-1 protect ARPE-19 cells against H2O2-induced oxidative stress by regulating the expressions of Nrf2, HO-1, Bcl-2, and caspase-3.

4 Protective effects of piperine on the retina of mice with streptozotocin-induced diabetes by suppressing HIF-1/VEGFA pathway and promoting PEDF expression

Pu Zhang , Yan-Dan Zhou , Yao Tan , Ling Gao

2021, 14(5):656-665. DOI: 10.18240/ijo.2021.05.04

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AIM: To evaluate the protective mechanisms of piperine in the retina of mice with streptozotocin-induced diabetes. METHODS: In experiments in vitro, stimulation by chemical hypoxia was established in ARPE-19 cells. Then, the expression of hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor A (VEGFA), and pigment epithelium-derived factor (PEDF) was assessed at the mRNA and protein levels. In experiments in vivo, diabetes mellitus was established by intraperitoneally injecting 150 mg/kg streptozotocin once. After 3wk of the onset of diabetes, 15 mg/kg piperine was intraperitoneally injected once daily for 1 or 3wk. Then, the retinal morphology and mRNA and protein expression were assessed. RESULTS: In hypoxia, 1-100 μmol/L piperine significantly decreased the expression of VEGFA mRNA and increased the expression of PEDF mRNA without affecting HIF-1α mRNA. Meanwhile, 100 μmol/L piperine substantially decreased the protein level of VEGFA and increased the protein level of PEDF. The HIF-1α protein level was also hampered by piperine. In the diabetic retina of mice, the morphological damage was alleviated by piperine. Likewise, the retinal vascular leakage was substantially decreased by piperine. Further, the protein levels of HIF-1α and VEGFA were significantly reduced by piperine. Moreover, the level of the antiangiogenic factor of PEDF dramatically increased by piperine. CONCLUSION: Piperine may exert protective effects on the retina of mice with diabetes via regulating the pro-antiangiogenic homeostasis composed of HIF-1/VEGFA and PEDF.

5 Expression levels of pro-inflammatory interleukin-8 and certain antimicrobial peptides in concurrent with bacterial conjunctivitis

Alaa El-Dien Shawky Hosny , Zeinab El-Demerdash El-Bazza , Mohammed Abdelhalim Ramadan , Maha Ahmed Shafik , Mahmoud Ahmed Shafeek , Rania Abdelmonem Khattab

2021, 14(5):666-675. DOI: 10.18240/ijo.2021.05.05

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AIM: To detect the quantitative expression levels of the pro-inflammatory interleukin-8 (IL8), antimicrobial peptides human beta defense-2 (HBD2), and human beta defense-3 (HBD3) genes in bacterial conjunctivitis. METHODS: The human conjunctival epithelial cells were obtained using the impression cytology technique from healthy controls and patients. The genes expression levels were determined utilizing a reverse transcription quantitative polymerase chain reaction (RT-qPCR). The contribution of causative agent type, the number of isolates and severity of clinical features, in the increase of genes expression was also determined. RESULTS: The RT-qPCR showed that IL8, HBD2, and HBD3 expression increased in bacterial conjunctivitis as compared to healthy control (P<0.001). In gram-negative bacterial conjunctivitis, HBD2 was highly up-regulated (P<0.001) compared to other types of bacterial conjunctivitis. In mixed bacterial conjunctivitis, a direct correlation between HBD2 up-regulation and HBD3 up-regulation was observed (P<0.05). The severity of clinical features was related to the up-regulation of IL8 and HBD2 (P<0.05). CONCLUSION: IL8, HBD2, and HBD3 are immune-effectors in infectious conjunctivitis. HBD2 is active during different bacterial conjunctivitis but is more released with gram-negative bacteria compared to gram-positive bacteria. HBD3 is an obvious defender in different bacterial conjunctivitis.

6 Iris manipulation during phacoemulsification: intraoperative and postoperative complications

Eric R. Williams , Jennifer L. Patnaik , D. Claire Miller , Anne M. Lynch , Richard S. Davidson , Malik Y. Kahook , Leonard K. Seibold

2021, 14(5):676-683. DOI: 10.18240/ijo.2021.05.06

[Abstract](909) [HTML](0) [PDF 644.52 K](664)

Abstract:
AIM: To quantify intraoperative and postoperative complications in complex phacoemulsification cataract extraction (phacoemulsification) with iris manipulation compared to non-complex and complex phacoemulsification without iris manipulation. METHODS: All phacoemulsification cases at the University of Colorado between January 1, 2014, and June 30, 2017 were included. Exclusion criteria for the primary outcome of intraoperative complications were planned combination surgery and eyes with less than 28d follow-up. Exclusion criteria for the secondary outcomes of postoperative complications were unplanned additional surgery, and chronic steroid eye drop use prior to surgery. Data including sex, race/ethnicity, surgery length, visual acuity, intraoperative and postoperative complications, and intraocular pressures (IOP) were collected and analyzed utilizing general linear and Logistic regression modeling. RESULTS: The medical records of 5772 eyes were reviewed (500 complex without iris manipulation, 367 with iris manipulation). The number of any intraoperative complication in the complex with iris manipulation and complex without iris manipulation groups was 15 (4.1%) and 26 (5.2%), respectively, compared to 41 (0.8%) in the non-complex group. Postoperative inflammation was found in 135 (2.8%) non-complex cases, 20 (4.1%) complex cases without iris manipulation, and 20 (5.6%) complex cases with iris manipulation. The adjusted odds ratio of postoperative inflammation in phacoemulsification with iris manipulation compared to non-complex was 2.3 (95%CI: 1.3-4.0, P=0.005). The rate of IOP spikes >10 mm Hg was significantly greater in cases with iris manipulation (P=0.001). CONCLUSION: Complex cases have more intraoperative complications. However, only complex cases with iris manipulation led to increase rates of postoperative inflammation and IOP spikes >10 mm Hg.

7 Comparing corneal outcome between femtosecond laser-assisted cataract surgery and conventional phaco surgery in Fuchs’ endothelial dystrophy patients: a randomized pilot study with 6mo follow up

Therese Krarup , Kathrine Rose , Aurore Marie-Laurence Akpé Mensah , Morten la Cour , Lars Morten Holm

2021, 14(5):684-692. DOI: 10.18240/ijo.2021.05.07

[Abstract](1041) [HTML](0) [PDF 654.18 K](644)

Abstract:
AIM: To compare the corneal outcome in Fuchs’ endothelial dystrophy (FED) patients between femtosecond laser-assisted cataract surgery (FLACS) and conventional phaco surgery (CPS). METHODS: This was a randomized controlled study comparing one eye surgery by FLACS and the contralateral eye operated by CPS (stop and chop technique) in FED patients. Central corneal thickness, corneal light backscatter, corneal densitometry, and central corneal endothelial cell count and hexagonality (noncontact endothelial cell microscope), and corrected distance visual acuity (CDVA) were assessed preoperatively and at day 1, 40, and 180 postoperatively. RESULTS: Totally 31 patients (16 women) were included. At day 40 postoperatively, the mean endothelial cell loss (ECL) was 23.67% by FLACS and 17.30% by CPS (P=0.53). At day 180 postoperatively, ECL was 25.58% in FLACS and 21.32% in CPS (P=0.69). Densitometry data in all layers and all annuli from anterior layer to posterior layer in annuli 0-2, 2-6, 6-10 and 10-12, total densitometry with all layers and all annuli was performed. A significant difference was found in 6-10 (posterior layer) at day 1 with -1.42 grayscale units (GSU; 95%CI: -2.66 to -0.19, P=0.02). In 10-12 (anterior layer, central layer and all layers) at day 40 were significant different with 7.7 (95%CI: 1.89 to 13.50, P=0.009), 3.97 (95%CI: 0.23 to 7.71, P=0.03), 4.73 GSU (95%CI: 0.71 to 8.75, P=0.02), respectively. In the remaining parameters we found no difference between the two groups (P>0.05). Three CPS eyes suffered from corneal decompensation. CONCLUSION: There is no significant difference in corneal outcome between FLACS and CPS. Endothelial cell density and pentacam corneal outcome may be inadequate as outcome parameters in FED patients.

8 Addressing the MSICS learning curve: identification of instrument-holding techniques used by experienced surgeons

Alexandra J. Berges , Zervin R. Baam , Angela Zhu , Shameema Sikder , Samuel Yiu , Ravilla D. Ravindran , Kunal S. Parikh

2021, 14(5):693-699. DOI: 10.18240/ijo.2021.05.08

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Abstract:
AIM: To identify instrument holding archetypes used by experienced surgeons in order to develop a universal language and set of validated techniques that can be utilized in manual small incision cataract surgery (MSICS) curricula. METHODS: Experienced cataract surgeons performed five MSICS steps (scleral incision, scleral tunnel, side port, corneal tunnel, and capsulorhexis) in a wet lab to record surgeon hand positions. Images and videos were taken during each step to identify validated hand position archetypes. RESULTS: For each MSICS step, one or two major archetypes and key modifying variables were observed, including tripod for scleral incision, tripod-thumb bottom for scleral tunnel, underhand-index to thumb grip for side port, index-contact tripod for corneal entry, and tripod-forceps for capsulorhexis. Key differences were noted in thumb placement and number of fingers supporting the instrument, and modifying variables included index finger curvature and amount of flexion. CONCLUSION: Identification of optimal hand positions and development of a formal nomenclature has the potential to help trainees adopt hand positions in an informed manner, influence instrument design, and improve surgical outcomes.

9 Optimizing the intraocular lens formula constant according to intraocular lens diameter

Abdul R El-Khayat , Paul Tesha

2021, 14(5):700-703. DOI: 10.18240/ijo.2021.05.09

[Abstract](657) [HTML](0) [PDF 557.82 K](575)

Abstract:
AIM: To determine whether the different diameters of a specific intraocular lens (IOL) have significantly different optimized SRK/T A constants and whether these new A constants can improve refractive outcomes. METHODS: Data were collected prospectively from Jan. 2011 to Dec. 2012 on all patients undergoing routine cataract surgery at a district general hospital in the UK. Patients were divided into three groups according to the size of the Akreos AO MI60 IOL used. A constants for the SRK/T formula were optimized according to the size of the IOL. These optimized A constants were then used to select future refractive outcomes. RESULTS: A total of 2398 cataract operations were performed during the study period of which 1131 met the inclusion criteria. The three optimized A constants for the different sized IOLs were 118.98, 119.13, 119.32. The difference between them was highly significant (P≤0.0001). Two optimized A constants for three sizes of IOL led to an improvement in refractive outcomes (from 93.4% to 94.6% of refractive outcomes within 1.00 D of predicted spherical equivalent). The optimized A constant for the largest IOL was based on a small number of cases and was not used. CONCLUSION: Optimizing the A constant for the three distinct sizes of the Bausch & Lomb Akreos MI60 lens lead to three significantly different A constants. In our practice, using two different optimized A constants for three different sized IOLs give the least refractive error, however, using three optimized A constants may give better results with a larger dataset.

10 Applications of the isolated-check visual evoked potential in primary open angle glaucoma with or without high myopia

Xia Wang , Ruo-Shi Li , Ya-Hui Wei , Yuan Fang , Tian Tian , Mei Li , Ying-Zi Pan

2021, 14(5):704-713. DOI: 10.18240/ijo.2021.05.10

[Abstract](996) [HTML](0) [PDF 995.36 K](651)

Abstract:
AIM: To explore the diagnostic performance of isolated-check visual evoked potential (icVEP) for primary open angle glaucoma (POAG) in both highly myopic and non-highly myopic populations and compare it with those of optical coherence tomography (OCT) and Heidelberg retinal tomography (HRT) parameters. METHODS: A total of 126 participants were recruited, including 31 highly myopic participants with POAG (HM-POAG), 36 non-highly myopic participants with POAG (NHM-POAG), 25 highly myopic participants without POAG (HM) and 34 controls without high myopia (Normal). All the participants underwent a complete ophthalmic examination. The signal-to-noise ratio (SNR) was used to assess the icVEP. Both qualitative and quantitative diagnostic performances of OCT, HRT and the icVEP were analyzed and compared. RESULTS: Based on the criterion of SNR≤1, the diagnostic performance of the icVEP in highly myopic subjects [area under the receiver operating characteristic curve (AUC)=0.862] was better than that in non-highly myopic subjects (AUC=0.789), and the SNR had fairly good specificity. In distinguishing the HM-POAG and HM groups, the AUC of the SNR was not different from those of the OCT and HRT parameters (P>0.05) in either the qualitative or quantitative comparison. In the qualitative analysis, the icVEP showed good consistency with damage to the central 10° of the visual field (kappa=0.695-0.747, P<0.001). CONCLUSION: The icVEP has the potential to discriminate individuals with and without POAG, especially in populations with high myopia.

11 Associations of lens thickness and axial length with outcomes of laser peripheral iridotomy

Ya-Meng Liu , Die Hu , Long-Fang Zhou , Jie Lan , Cheng-Cheng Feng , Xiao-Yun Wang , Xiao-Jing Pan

2021, 14(5):714-718. DOI: 10.18240/ijo.2021.05.11

[Abstract](878) [HTML](0) [PDF 551.85 K](654)

Abstract:
AIM: To investigate the association of axial length (AL), lens thickness (LT), and lens vault (LV) with postoperative anterior chamber angle metrics after laser peripheral iridotomy (LPI). METHODS: Prospective observational study of 69 patients (97 eyes) were diagnosed as primary angle-closure suspect (PACS), primary angle closure (PAC) or primary angle-closure glaucoma (PACG). AL, LT, anterior central chamber depth (ACD), angle opening distance (AOD), trabecular iris angle (TIA), and angle recess area (ARA) were measured before and 1wk after LPI. The association between AL, LT, LV with ACD, AOD, TIA, ARA were analyzed by comparing the differences between preoperative and postoperative measurements for anterior segment biometric parameters. RESULTS: ACD, AOD, TIA, and ARA were significantly increased after LPI (all P<0.05). Greater LT was significantly associated with greater postoperative increases in ACD, AOD, TIA, and ARA (all P<0.05). AL was not significantly associated with changes of anterior segment biometric parameters. Greater LV was significantly associated with greater postoperative increases in ACD, AOD, and TIA (all P<0.05), but was not significantly associated with changes of ARA. CONCLUSION: Greater baseline LT and LV measurements are associated with greater increases in anterior segment biometric parameters after laser peripheral iridotomy. AL are not associated with the change of anterior segment biometric parameters.

12 Comprehensive evaluation of intravitreal conbercept versus half-dose photodynamic therapy for chronic central serous chorioretinopathy

Jian-Bo Mao , Cai-Yun Zhang , Chen-Yi Liu , Yun Zhang , Jing-Jing Lin , Zhao-Kai Xu , Yi-Qi Chen , Yuan-Yuan Fan , Shi-Xin Zhao , Li-Jun Shen

2021, 14(5):719-724. DOI: 10.18240/ijo.2021.05.12

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AIM: To compare the safety and efficacy of conbercept intravitreal injection and half-dose photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC). METHODS: This study was retrospective. Thirty-seven patients (37 eyes) with chronic CSC received conbercept injections while 57 patients (57 eyes) were treated with half-dose PDT. All subjects were followed in 6mo. Outcome measures included change in best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and resolution of subretinal fluid (SRF). RESULTS: There was no adverse event observed in either treatment group. At the 6-month follow-up, 26 eyes (70.3%) in the conbercept group and 54 eyes (94.7%) in the half-dose PDT group (P<0.05) reached full resolution of SRF. The mean logarithm of the minimum angle of resolution (logMAR) BCVA significantly improved (P<0.001) in both treatment groups with better outcome at early phase in the half-dose PDT group (2wk, 1, and 2mo, P<0.05). All subjects experienced significant CMT improvement (P<0.001) with no statistical difference between the two groups (P>0.05). The SFCT also improved in all subjects (P<0.001) with better outcome in the half-dose PDT group (P<0.05). CONCLUSION: Both intravitreal conbercept and half-dose PDT are safe to use in treating chronic CSC. By 6mo, both treatment groups are efficacious in improving BCVA, reducing CMT and SFCT, and resolving SRF in eyes with chronic CSC. Half-dose PDT may show better outcome at initial phase of treatment in chronic CSC. Longer follow-up period is necessary to study for long-term effect and safety.

13 Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with macular edema secondary to uveitis

Zheng Liu , Qing-Qin Tao , Xiao-Rong Li , Xiao-Min Zhang

2021, 14(5):725-731. DOI: 10.18240/ijo.2021.05.13

[Abstract](835) [HTML](0) [PDF 877.92 K](613)

Abstract:
AIM: To assess the correlation between disorganization of the retinal inner layers (DRIL) and best-corrected visual acuity (BCVA) in patients with uveitis and macular edema (UME) who underwent systemic treatment using optical coherence tomography (OCT). METHODS: A retrospective clinical study of 23 patients (30 eyes) with DRIL and 23 patients (31 eyes) without DRIL secondary to UME were included. All patients underwent comprehensive ophthalmic examinations at baseline, 3, 6, and 12mo after local and systemic treatment. The OCT-based parameters included foveal center point thickness (FCPT), mean thickness (MT), and diameters of DRIL in horizontal and vertical directions. BCVA and OCT-based parameters were compared between the two groups. The relationship between each OCT parameter and BCVA was evaluated using linear correlation and regression analysis. RESULTS: At the initial visit, the mean baseline FCPT was 441.03±128.68 μm in the eyes with DRIL and 337.26±99.31 μm in the eyes without DRIL (P=0.001). No significant differences were observed in MT (P=0.357). The mean size of transverse and vertical diameters of DRIL was 684.07±267.51 and 267.07±104.61 μm at baseline, respectively. There was significant improvement in BCVA and OCT-based parameters at 3, 6, and 12mo in all cases (P<0.001 for each timepoint). In addition, significant differences were detected in BCVA and OCT parameters between eyes with and without DRIL at each time point (P<0.01 for each timepoint). A greater DRIL range at baseline was associated with a worse baseline BCVA (transverse diameter of DRIL: r=0.875, P<0.001; vertical diameter of DRIL: r=0.622, P<0.001). The transverse diameter of baseline DRIL was found to be significantly correlated with the final BCVA (P=0.003). CONCLUSION: The improvement in BCVA is associated with DRIL in patients with UME. DRIL is an easy-to-determine and robust imaging biomarker that could help predict BCVA prognosis in eyes with UME.

14 Short-term effects of intravitreal Conbercept injection combined with laser photocoagulation on macular edema secondary to ischemic retinal vein occlusion

Zheng-Feng Liu , Xing-Rong Wang , Xiao-Yan Zhang , Xue-Mei Pan , Rui-Xue Zhang , Hong-Sheng Bi , Ying Wen

2021, 14(5):732-736. DOI: 10.18240/ijo.2021.05.14

[Abstract](1669) [HTML](0) [PDF 375.67 K](613)

Abstract:
AIM: To observe changes in the best-corrected visual acuity (BCVA), central macular thickness (CMT), and central choroidal thickness (CCT) of patients with macular edema (ME) secondary to ischemic retinal vein occlusion (iRVO) following intravitreal Conbercept injection. METHODS: This retrospective study included 33 eyes from 33 patients who received intravitreal injections of Conbercept for ME secondary to iRVO. Treatments were performed on a 3+pro re nata (3+PRN) basis. All of the patients were examined by fundus fluorescein angiography and spectral domain optical coherence tomography at the first visit. Laser photocoagulation was performed in the nonperfusion area of the retina of all eyes after the first injection. BCVA, CMT, and CCT were observed before and after 6mo of treatment. The number of injections necessary to achieve improved vision was also noted. RESULTS: Following Conbercept treatment, the mean BCVA significantly improved from 0.81±0.39 at baseline to 0.41±0.25 and 0.43±0.29 logMAR in the third and sixth months, respectively (both P=0.000). The CMT of the patients at baseline was 556.75±98.57 μm; 304.78±68.53 and 306.85±76.77 μm 3 and 6mo after treatment, respectively (both P=0.000 vs baseline). The CCTs of the patients at baseline, 3 and 6mo after treatment were 304.63±57.83, 271.31±45.53, and 272.29±39.93 μm, respectively (P=0.026 and 0.035 vs baseline). No severe adverse event relevant to the therapy was noted, and the average number of injections delivered was 3.35. CONCLUSION: Intravitreal Conbercept injection combined with laser photocoagulation appears to be a safe and effective treatment for ME secondary to iRVO in the short-term.

15 Optical and visual quality comparison of implantable collamer lens and femtosecond laser assisted laser in situ keratomileusis for high myopia correction

Zheng Jiang , Hua Wang , Dong-Qiang Luo , Jiao Chen

2021, 14(5):737-743. DOI: 10.18240/ijo.2021.05.15

[Abstract](2004) [HTML](0) [PDF 714.38 K](644)

Abstract:
AIM: To compare clinical outcomes and refractive stability of implantable collamer lens (ICL) implantation and femtosecond laser assisted laser in situ keratomileusis (FS-LASIK) for high myopia correction. METHODS: The Optical Quality Analysis System (OQAS) was used to evaluate clinical outcomes objectively after operation for high myopia correction. We compared the two procedures in terms of 1-year changes in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), safety index, efficacy index, spherical equivalent, modulation transfer function (MTF) cutoff frequency, strehl ratio (SR) and objective scatter index (OSI). RESULTS: At 1y postoperatively, the safety indices were 1.33±0.27 in ICL group, and 1.17±0.24 in FS-LASIK group. 39.58% in the ICL group and 27.59% in the FS-LASIK group gained CDVA in 2 lines or better than that in preoperative CDVA. The efficacy indices were 1.28±0.22 in ICL group, and 1.13±0.26 in FS-LASIK group. The changes of spherical equivalent from 1wk to 1y postoperatively was -0.12±0.37 D in ICL group, and -0.79±0.58 D in FS-LASIK group (P<0.05). Spherical equivalent within ±0.50 D was achieved in 97.92% in ICL group and 68.97% in FS-LASIK group. MTF cutoff frequency were higher with ICL as compared to FS-LASIK (P<0.05) at each postoperative follow-up stage; for postoperative 1mo later, SR was statistically significant difference between two groups (P<0.05); with no statistically significant difference in OSI between two groups (P>0.05) in postoperative 3mo later. CONCLUSION: ICL implantation and FS-LASIK procedures both provide good safety and predictability in high myopia correction. ICL implantation provides better clinical outcomes and refractive stability than FS-LASIK.

16 Transepithelial photorefractive keratectomy for myopia: effect of age and keratometric values

Amanda Nur Shinta Pertiwi , Indra Tri Mahayana , Agus Supartoto , Wasisdi Goenawan , Suhardjo

2021, 14(5):744-749. DOI: 10.18240/ijo.2021.05.16

[Abstract](872) [HTML](0) [PDF 453.59 K](713)

Abstract:
AIM: To investigate demographic and preoperative factors increasing the risk of ametropia following transepithelial photorefractive keratectomy (transPRK) in myopia and myopic astigmatism. METHODS: This retrospective cohort study included myopic eyes (-0.50 to -8.75 D) with or without astigmatism (up to 3.50 D) enrolled at Dr. Yap Eye Hospital Yogyakarta. TransPRK was performed using Technolaz 217z100 excimer laser. Subjects were clustered into ametropia and emmetropia group based on uncorrected distance visual acuities (UDVA) 3mo post-operatively. Multiple preoperative and intraoperative parameters were analyzed using Logistic regression to obtain their effect on ametropia risk following transPRK. RESULTS: A total of 140 eyes of 87 consecutive subjects were studied. Prevalence of ametropia following transPRK was 20 (14.29%) eyes. Subjects in ametropia group were significantly older than the emmetropia group (31.80±14.23 vs 18.88±2.41, respectively; P<0.001). Bivariate Logistic regression analysis showed that older age (OR=1.23), higher preoperative spherical equivalent (>-6 D; OR=12.78), steeper anterior keratometric readings (Kmax>45 D and mean K>44 D; OR=4.28 and 4.35, respectively) increased the risk of ametropia following transPRK. Adjusted multivariate Logistic regression analysis showed that age was the strongest predictor for the incidence of ametropia following transPRK. Complications of transPRK were overcorrection, suspected posterior keratoectasia and accommodation insuffiency. CONCLUSION: Older age can be the strongest factor for increasing ametropia risk following transPRK. Cut-off points of Kmax and mean K at 45 and 44 D respectively are proposed as the predictors for ametropia following transPRK.

17 Correlation of the retinopathy degree with the change of ocular surface and corneal nerve in patients with type 2 diabetes mellitus

Jia-Xin Han , He Wang , Huan-Huan Liang , Jian-Xin Guo

2021, 14(5):750-758. DOI: 10.18240/ijo.2021.05.17

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Abstract:
AIM: To investigate the change of ocular surface and corneal nerve and their correlation in patients suffering from type 2 diabetes mellitus under different degrees of retinopathy. METHODS: Totally 129 type 2 diabetes mellitus patients (257 eyes) were included. They were divided into three groups: no diabetic retinopathy (NDR) group (33 cases, 66 eyes), non-proliferative diabetic retinopathy (NPDR) group (32 cases, 64 eyes), and proliferative diabetic retinopathy (PDR) group (34 cases, 67 eyes). Healthy normal individuals were enrolled as controls (30 cases, 60 eyes). Ocular Surface Disease Index (OSDI) questionnaire was completed by all subjects, and dry eye analyzer was applied to examine tear meniscus height (TMH), first tear break-up time (FTBUT), average tear break-up time (ATBUT), tear film lipid layer thickness classification, and meibomian gland loss (MGL) score. Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and corneal nerve fiber tortuosity (CNFT) were examined by in vivo confocal microscopy (IVCM). The differences and correlation among these parameters were analyzed. RESULTS: Total OSDI score, TMH, FTBUT, ATBUT, tear film lipid layer thickness, MGL score, CNFD, CNBD, CNFL, and CNFT were statistically different among the four groups (P<0.05). In NDR group, CNFL was positively correlated with TMH (r=0.493, both P<0.01) and ATBUT (r=0.437, P<0.05). CNFL in NPDR group was positively correlated with TMH (r=0.642, P<0.01) and ATBUT (r=0.6, P<0.01). CNFL in PDR group was positively correlated with TMH (r=0.364, P<0.05) and ATBUT (r=0.589, P<0.01), with low negative correlation with MGL score (r=-0.331, P<0.05). CONCLUSION: With the progression of diabetic retinopathy, TMH, BUT, lipid layer thickness, CNFL, CNFD, and CNBD gradually decreased, while total OSDI score, MGL score, and CNFT increased. CNFL is correlated with TMH and ATBUT in diabetic patients.

18 Clinical characteristics and prognostic factors for visual outcome in 669 patients with intraocular foreign bodies

Yu-Zhu Gao , Yi-Fan Zhang , Ming Zhang , Han-Yue Xu , Xu-Rui Jin

2021, 14(5):759-765. DOI: 10.18240/ijo.2021.05.18

[Abstract](677) [HTML](0) [PDF 406.25 K](652)

Abstract:
AIM: To describe the clinical characteristics and analyze prognostic factors that influence visual outcome in 669 patients with intraocular foreign bodies (IOFBs). METHODS: Medical records of 669 patients with IOFBs from West China Hospital were reviewed. Best corrected visual acuity (BCVA) values were recorded using standard Snellen acuity chart and were converted to logarithm of the minimum angle of resolution (logMAR) scale for statistical analysis. The visual outcome was defined by the final BCVA (excellent visual outcome: final BCVA of 20/40 or better; poor visual outcome: final BCVA less than 20/200). Statistical analysis of collected data was performed using IBM SPSS Statistics version 23. A 2-tailed P value of less than 0.05 was considered statistically significant throughout the study. RESULTS: The average age ranged from 1 to 79 years old (mean age, 34.8±12.7 SD) and the majority of patients were men (626, 93.6%). The major cause of ocular injury was hammering (383, 57.2%). Almost all the patients (97.8%) underwent surgeries (97.8%) and the average time interval between injury and surgery was 26.4±322.3d (0-7300), while 327 patients received surgeries within 24h (48.9%) and 590 patients received surgeries within seven days (88.2%) after IOFBs injury. The poor BCVA was associated with older age (P=0.013), larger IOFBs size (P<0.001), presence of complications (P<0.001) and worse presenting BCVA (P<0.001). On the contrary, younger age (P=0.005), smaller IOFBs size (P<0.001), absence of complications (P<0.001) and better presenting BCVA (P<0.001) were considered to relate to excellent BCVA. CONCLUSION: Multiple prognostic factors may influence the final visual outcome, including age, size of IOFBs, complications and presenting BCVA. Meanwhile, further education and promotion on eye protection should be taken for the improvement on self-protection and self-health awareness.

19 Lipid accumulation and protein modifications of Bruch’s membrane in age-related macular degeneration

Li-Hui Meng , You-Xin Chen

2021, 14(5):766-773. DOI: 10.18240/ijo.2021.05.19

[Abstract](923) [HTML](0) [PDF 1.06 M](725)

Abstract:
Age-related macular degeneration (AMD) is a progressive retinal disease, which is the leading cause of blindness in western countries. There is an urgency to establish new therapeutic strategies that could prevent or delay the progression of AMD more efficiently. Until now, the pathogenesis of AMD has remained unclear, limiting the development of the novel therapy. Bruch’s membrane (BM) goes through remarkable changes in AMD, playing a significant role during the disease course. The main aim of this review is to present the crucial processes that occur at the level of BM, with special consideration of the lipid accumulation and protein modifications. Besides, some therapies targeted at these molecules and the construction of BM in tissue engineering of retinal pigment epithelium (RPE) cells transplantation were listed. Hopefully, this review may provide a reference for researchers engaged in pathogenesis or management on AMD.

20 Via pars plana anterior iris enclavation IOL fixation

Tomaso Caporossi , Ruggero Tartaro , Giancarlo Albani , Francesco Barca , Fabrizio Giansanti , Stanislao Rizzo

2021, 14(5):774-776. DOI: 10.18240/ijo.2021.05.20

[Abstract](827) [HTML](0) [PDF 515.01 K](668)

Abstract:
AIM: To describe a via pars plana anterior iris enclavation intraocular lens (IOL) fixation technique METHODS: A total of 35 consecutive aphakic vitrectomised patients (average age 71.12±10.12y) underwent pars plana vitrectomy (PPV) and via pars plana anterior iris enclavation IOL fixation. RESULTS: The mean preoperative best corrected visual acuity (BCVA) was 0.11±0.14 logMAR, the mean postoperative BCVA was 0.07±0.11 logMAR. The preoperative mean spherical equivalent was 7.22±4.21 D. The final mean spherical equivalent was -0.25±0.15 D. No eyes had hypotony, retinal or choroidal detachment or endophthalmitis. CONCLUSION: This technique may be a safe and useful in the case of aphakia, and a prospective study would be useful to confirm this findings.

21 Histological observation in pachyvessels in a patient with choroidal melanoma

Satoru Kase , Kousuke Noda , Susumu Ishida

2021, 14(5):777-779. DOI: 10.18240/ijo.2021.05.21

[Abstract](697) [HTML](0) [PDF 1.06 M](592)

Abstract:

22 Glaucoma secondary to trabecular meshwork precipitates: a case report of Grant’s syndrome

Ya-Hui Wei , Tian Tian , Rui-Lin Zhu , Mei Li

2021, 14(5):780-782. DOI: 10.18240/ijo.2021.05.22

[Abstract](780) [HTML](0) [PDF 451.43 K](603)

Abstract:

23 Spontaneous resolution of traumatic cataract after removal of a ferrous intravitreal foreign body using external magnetic extraction through a pars plana incision

Zhi-Tao Su , Zhe Xu , Pan-Pan Ye , Jian Ma , Li Zhang , Zhi-Qing Chen , Ji-Jian Lin , Xiao-Yun Fang , Yao Wang

2021, 14(5):783-786. DOI: 10.18240/ijo.2021.05.23

[Abstract](750) [HTML](0) [PDF 917.39 K](635)

Abstract:

24 An unusual case report of Burkholderia cepacia endophthalmitis

Huan Chen , Jing-Jia Zhang , Ying-Chun Xu , Jun-Jie Ye

2021, 14(5):787-790. DOI: 10.18240/ijo.2021.05.24

[Abstract](815) [HTML](0) [PDF 749.20 K](596)

Abstract:

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Volume 14,Issue 5,2021 Table of Contents