Volume 15,Issue 11,2022 Table of Contents

1 Assessment of knowledge, perception, and practice patterns of Jordanian optometrists during COVID-19 pandemic: a cross-sectional online survey

Mera F. Haddad , Yousef Khader

2022, 15(11):1729-1735. DOI: 10.18240/ijo.2022.11.01

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AIM: To investigate knowledge, risk perception, and attitude towards corona virus disease 2019 (COVID-19) and infection control measures among optometrists in Jordan. METHODS: A cross-sectional survey was distributed through social media platforms to optometrists registered with the Jordanian syndicate and Jordanian association of optics. Information on participants’ socio-demographic characteristics, knowledge of clinical features of COVID-19, risk assessment and infection control measures for preventing disease transmission were collected. RESULTS: A total of 135 optometrists (80 females and 55 males) with a mean age of 32±10y responded to the survey. Most optometrists were aware of COVID-19 symptoms, modes of transmission and measures for preventing COVID-19 and transmission in the ophthalmic setup. However, more than half of the optometrists did not receive any training about protection or infection control by their employers at their work place. Social media was the most common source of information on COVID-19 (76%). Most optometrists (85.2%) thought that the virus could be detected in tears, and 45.9% thought that red eye is a symptom of COVID-19. CONCLUSION: Optometrists in Jordan are aware of the clinical features and preventive measures related to COVID-19 infection. However, training on infection control is lacking and needs to be improved. Guidelines by international professional optometric associations should be promoted through regional and national associations to all registered optometrists and access to peer review. Journals should be encouraged to ensure that the knowledge about the pandemic is up to date and accurate.

2 Comprehensive assessment of growth factors, inflammatory mediators, and cytokines in vitreous from patients with proliferative diabetic retinopathy

Qiao-Yun Gong , Guang-Yi Hu , Su-Qin Yu , Tian-Wei Qian , Xun Xu

2022, 15(11):1736-1742. DOI: 10.18240/ijo.2022.11.02

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AIM: To assess alterations in growth factors, inflammatory mediators, and cytokines associated with vitreous-retinal diseases in vitreous humor from patients with proliferative diabetic retinopathy (PDR), and to identify potential new treatment targets and strategies. METHODS: Control vitreous samples were collected from patients with macular hole, epiretinal membranes, or rhegmatogenous retinal detachments, and PDR samples from patients with complications of PDR, who required pars plana vitrectomy. Specimens were stored at −80℃ and then investigated by Luminex multi-factor assay. Parametric and nonparametric analyses of demographic characteristics and cytokine expression levels were conducted using SPSS. RESULTS: There were no significant differences in demographic characteristics between patients with and without PDR. Expression levels of growth factors [platelet-derived growth factor (PDGF)-AA, glial cell line-derived neurotrophic factor (GDNF), and vascular endothelial growth factor A (VEGFA)], inflammatory mediators [interleukin (IL)-8, IL-11, and tumor necrosis factor-α (TNF-α)] and cytokines [chemokine C-X-C ligand (CXCL)10, interferon-γ (IFN-γ), and granulocyte macrophage-colony stimulating factor (GM-CSF)] were significantly elevated in vitreous humor from patients with PDR compared with those in the control group (all P<0.05). Further, VEGFA levels were lower in patients with PDR treated with anti-VEGF injection than those who were not (P<0.05), and there was no difference between the PDR group treated with anti-VEGF and controls (P>0.05). CONCLUSION: This proof-of-concept study demonstrates the potential for combinational therapeutic strategies to ameliorate diabetic retinopathy progression by targeting growth factors, inflammatory factors, and cytokines, in addition to VEGFA.

3 A Trojan horse biomimetic delivery system using mesenchymal stem cells for HIF-1α siRNA-loaded nanoparticles on retinal pigment epithelial cells under hypoxia environment

Lei Zhang , Jie-Jing Yan , Hai-Yan Wang , Mu-Qiong Li , Xi-Xi Wang , Li Fan , Yu-Sheng Wang

2022, 15(11):1743-1751. DOI: 10.18240/ijo.2022.11.03

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AIM: To demonstrate the feasibility of mesenchymal stem cell (MSC)-mediated nano drug delivery, which was characterized by the “Trojan horse”-like transport of hypoxia-inducible factor-1α small interfering RNA (HIF-1α siRNA) between MSCs and retinal pigment epithelial cells (RPE) under hypoxia environment. METHODS: Plasmid and lentivirus targeting the human HIF-1α gene were designed and constructed. HIF-1α siRNA was encapsulated into poly(lactic-co-glycolic acid) nanoparticles (PLGA-NPs) through the water-in-oil-in-water (w/o/w) multiple emulsion technique. The effect of PLGA-NPs uptake on the expression of HIF-1α mRNA was tested in RPE cells by real-time quantitative polymerase chain reaction (qPCR) and additional transfected conditions were used as control, including lentivirus group, nude plasmid group and blank PLGA group. MSCs were transfected with the NPs and the transfection efficacy was evaluated by flow cytometry. Transwell co-culture system of transfected MSCs and RPE cells was constructed under hypoxia environment. The effects of MSC-loaded HIF-1α siRNA PLGA-NPs on proliferation, apoptosis, and migration of RPE cells were then evaluated. The effect of transfected MSCs on HIF-1α expression of RPE cells was analyzed by using qPCR at the time points 24h, 3d, and 7d. RESULTS: The average diameter of PLGA-NPs loaded with HIF siRNA was 314.1 nm and the zeta potential was -0.36 mV. The transfection efficiency of PLGA-NPs was 67.3%±5.2% into MSCs by using flow cytometry. Compared with the lentivirus group, the PLGA-NPs loaded with HIF-1α siRNA can effectively reduce the expression of HIF-1α mRNA up to 7d in RPE (0.63±0.05 at 7d, P<0.001). In the Transwell co-culture system of transfected MSCs and RPE, the abilities of proliferation (2.34±0.17, 2.40±0.28, 2.47±0.24 at 48h, F=0.23, P=0.80), apoptosis (14.83%±2.43%, 12.94%±2.19%, 12.39%±3.21%; F=0.70, P=0.53) and migration (124.5±7.78, 119.5±5.32, 130±9.89, F=1.33, P=0.33) of the RPE cells had no differences between MSC-loaded HIF-1α siRNA PLGA-NPs and other groups. The inhibition of PLGA on the HIF-1α mRNA expression in RPE cells could continue until the 7th day, the level of HIF-1α mRNA was lower than that of other groups (F=171.98, P<0.001). CONCLUSION: The delivery of PLGA-NPs loaded with HIF-1α siRNA carried by MSCs is found to be beneficial temporally for HIF-1α mRNA inhibition in RPE cells under hypoxia environment. The MSC-based bio-mimetic delivery of HIF-1α siRNA nanoparticles is a potential method for therapy against choroidal neovascularization.

4 Association of CFH and MAP1LC3B gene polymorphisms with age-related macular degeneration in a high-altitude population

Rui-Juan Guan , Xin Yan , Ling Li , Ze-Feng Kang , Xiao-Ying Zhang , Huan-Juan Yang

2022, 15(11):1752-1756. DOI: 10.18240/ijo.2022.11.04

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Abstract:
AIM: To evaluate the association of complement factor H (CFH) and microtubule-associated protein 1 light chain 3 beta (MAP1LC3B) gene polymorphisms with the risk of age-related macular degeneration (AMD) in a high-altitude population. METHODS: The study group consisted of 172 participants with symptoms of AMD who were examined and diagnosed between January 2019 and June 2020. The control group was composed of 120 healthy individuals. Each participant was required to provide two milliliters of peripheral blood for DNA extraction. Two single nucleotide polymorphisms (SNPs) of CFH (rs1061170 and rs800292) and two SNPs of MAP1LC3B (rs8044820 and rs9903) were genotyped. The genotypes and allele frequencies of the SNPs in the study and control groups were further compared using Chi-square and Fisher’s exact tests. RESULTS: In a high-altitude population, the nominally significant differences of rs800292 and rs9903’s genotype AG frequencies were observed in the AMD group (P=0.034 and 0.004, respectively). The frequencies of allele G of rs800292 and allele A of rs9903 were also significantly different in the AMD group compared to the control [(P=0.034, OR=0.70, 95%CI: 0.50-0.98) and (P=0.004, OR=1.60, 95%CI: 1.15-2.22), respectively]. No significant differences in the genotype distributions (P=0.16 and 0.40, respectively) and allele frequencies (P>0.05) of rs1061170 and rs8044820 were observed in the AMD group. CONCLUSION: Genotype AG of rs800292 may be a protective factor for AMD. Conversely, rs9903 seems to be a risk factor for AMD. Therefore, allele G of rs800292 may be a protective factor, and allele A of rs9903, a risk factor for AMD in Qinghai high-altitude population.

5 A modified 3D stereophotogrammetry-based distraction test for assessing lower eyelid tension

Xiao-Yi Hou , Alexander C. Rokohl , Marius M. Meinke , Sen-Mao Li , Ming Lin , Ren-Bing Jia , Yong-Wei Guo , Ludwig M. Heindl

2022, 15(11):1757-1764. DOI: 10.18240/ijo.2022.11.05

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AIM: To investigate the reliability of a modified three-dimensional distraction test (3D-DT) and three-dimensional pinch test (3D-PT) for assessing lower eyelid tension (LET). METHODS: A cross-sectional study was conducted among 97 volunteers including 97 eyelids with no history of trauma, tumor, or reconstructive surgeries. Six three-dimensional photographs were acquired for each participant, including two photographs obtained in a neutral position (NP), two using a modified 3D-DT with a 15.9-grammes stainless steel eyelid hook performed, and two using 3D-PT. RESULTS: The mean absolute differences between NP, 3D-DT, and 3D-PT measurements varied between 0.07 and 7.42, 0.10 and 13.10, and 0.07 and 15.97, respectively; technical error of measurement varied between 0.05 and 7.81, 0.09 and 10.19, and 0.07 and 12.47, respectively; and relative error measurements varied between 0.10% and 11.50%, 0.16% and 30.51%, and 0.11% and 38.75%, respectively. For intra-rater reliability, the intraclass correlation coefficients (ICCs) were more than 0.80 in seven out of eight measurements obtained in the NP and 3D-DT, whereas those obtained in the 3D-PT were as low as less than 0.30 by rater 1; the ICCs of all the measurements obtained in all the positions (NP, 3D-DT, and 3D-PT) were more than 0.80 by rater 2. For inter-rater reliability six out of eight NP and 3D-DT measurements had an ICC greater than 0.80, whereas those of 3D-PT measurements were less than 0.30. For intra-method reliability, the ICCs of all the NP measurements were more than 0.87, whereas those of the six 3D-DT measurements and four 3D-PT measurements were more than 0.80. CONCLUSION: Our study results prove that the modified 3D-DT, which involves the use of an eyelid hook, can be a highly reliable method for evaluating LET. Furthermore, this novel and simple method may be utilized as the basis for further investigation and routine pre- and postoperative clinical evaluation.

6 Endoscopic dacryocystorhinostomy with mucosal anastomosing in chronic dacryocystitis with three categories of ethmoid sinuses

Yao-Hua Wang , Wen-Hao Jiang , Yun-Hai Tu , Guang-Ming Zhou , Wen-Can Wu , Bo Yu

2022, 15(11):1765-1771. DOI: 10.18240/ijo.2022.11.06

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AIM: To evaluate the outcome of endoscopic dacryocystorhinostomy (En-DCR) with mucosal anastomosis in chronic dacryocystitis patients, with various categories of ethmoid sinuses. METHODS: Between July 2015 and September 2019, 1439 adult patients, representing 1623 affected eyes, presented with chronic dacryocystitis and were scheduled for En-DCR. The categories of ethmoid sinuses were preoperatively determined, using computed tomography-dacryocystography (CT-DCG), and were classified as category 1 (C1), category 2 (C2), and category 3 (C3). No sinuses anterior to the posterior lacrimal crest defined as C1. Sinuses found between the anterior edge of the lacrimal bone and the posterior lacrimal crest defined as C2. Sinuses found anterior to the lacrimal bone suture defined as C3. At the end of surgery, the dacryocyst and nasal mucosa were anastomosed in C1, and the dacryocyst mucosa and anterior ethmoid sinus were anastomosed in C2 and C3 ethmoid sinus patients. The surgical success rate and related complications, in patients with 3 categories of ethmoid cells, were monitored and documented. RESULTS: Postoperative data was obtained for 179 C1 affected eyes, 878 C2 affected eyes, and 432 C3 affected eyes. The overall success rate of En-DCR was 93.0% (1385/1489). Additionally, the success rates were comparable among the different ethmoid categories at 12mo post operation. We demonstrated that the major reason for surgical failure was intranasal ostial closure, due to granulation or scar tissue. CONCLUSION: En-DCR is a feasible and highly effective primary treatment for chronic dacryocystitis. To ensure surgical success, the surgery protocol must be designed in accordance with the category of ethmoid sinuses present in individual patient.

7 Effects of rigid gas permeable contact lens on morphological parameters and vision-related quality of life in keratoconus patients

Yue Xu , Yun Wang , Xiao-Feng Zhang

2022, 15(11):1772-1781. DOI: 10.18240/ijo.2022.11.07

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AIM: To evaluate the effect of rigid gas permeable contact lens (RGP-CL) on corneal morphological parameters and vision-related quality of life in keratoconus (KC) patients. METHODS: Totally 57 eyes of 30 KC patients who were followed-up for more than two years, including 17 RGP wearers (32 eyes) and 13 non-wearers (25 eyes) were retrospectively analyzed. Initial medical history and corneal topography were collected at baseline. Corneal topography, corneal aberration, optical coherence tomography, and vision-related quality of life questionnaires were performed at the last follow-up. RESULTS: According to corneal topography, increase of the flattest keratometric values was higher in RGP wearers than in non-wearers (P=0.038). The morphological parameters, including symmetry index of front corneal curvature (P=0.004) and Baiocchi-Calossi-Versaci index front (P=0.047), were lower in RGP wearers than in non-wearers. Vertical coma was smaller in RGP wearers than non-wearers in 3.0, 5.0, 6.0, and 7.0 mm pupil diameters, respectively (P<0.05). The environmental triggering domain of ocular surface disease index was worse in RGP wearers as compared to non-wearers (P=0.003). At the last follow-up, there were no significant differences in constituent ratios of KC progression, corneal thickness topography, epithelial thickness topography, morphological parameters of corneal topography, and other questionnaire scores between the two groups (all P>0.05). CONCLUSION: Long-term use of RGP does not worsen KC but may cause corneal epithelial remodeling to increase symmetry of corneal anterior surface, reduce corneal vertical coma and improve visual quality. However, RGP wearing causes a slight decrease in vision-related quality of life. The occurrence of ocular surface symptoms is mainly associated with environmental triggering factors.

8 Diagnostic evaluation of optical coherence tomography parameters in normal, preperimetric and perimetric glaucoma patients

Aimy Mastura Zurairah Yusof , Othmaliza Othman , Seng Fai Tang , Mohd Rohaizat Hassan , Norshamsiah Md Din

2022, 15(11):1782-1790. DOI: 10.18240/ijo.2022.11.08

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AIM: To compare the diagnostic ability of glaucoma parameters measured by the optical coherence tomography (OCT) in normal, preperimetric glaucoma (PPG) and perimetric glaucoma (PG) patients. METHODS: This cross-sectional observational study includes 127 eyes of 127 subjects. Patients were divided into PPG (51 eyes), PG (46 eyes), and normal controls (30 eyes) based on clinical optic disc assessment and Humphrey visual field changes. The Heidelberg Spectralis OCT machine using Glaucoma Module Premium Edition software was used to measure the retinal nerve fiber layer (RNFL) and Bruch’s membrane opening-minimum rim width (BMO-MRW) to assess the optic nerve head and ganglion cell layer (GCL) thickness in the macula. RESULTS: RNFL, MRW, and GCL thickness were all significantly thinner in PG compared to PPG and the normal group. The BMO-MRW parameters showed better specificity (>70%) at 90% specificity compared to both RNFL and GCL parameters to discriminate normal, PPG, and PG patients. All BMO-MRW parameters showed higher area under curves (AUC) compared to RNFL and GCL parameters with the highest AUC observed in the superotemporal sector of the BMO-MRW (AUC=0.819 and and 0.897 between normal and PPG and PG groups respectively). CONCLUSION: While the BMO-MRW best discriminates PPG and PG against normal eyes, GCL parameters poorly differentiate the three groups.

Valence A Jordan , Lizette L Mowatt

2022, 15(11):1791-1797. DOI: 10.18240/ijo.2022.11.09

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AIM: To determine the vision-related quality-of-life of glaucoma patients and the association between clinical and socioeconomic factors, and vision-related quality-of-life. METHODS: This was a cross-sectional study. Consecutive patients with glaucoma were interviewed using a modified 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) by a single interviewer. Statistical analysis was done to find associations between patient variables and vision-related quality-of-life scores. Confidentiality and anonymity were maintained. RESULTS: Ninety-six participants were recruited in the study. There were 44 males and the mean age for males and females was 65.7 and 69.5y, respectively. The mean composite score was 71.2 (with a maximum possible score of 100), with the highest mean score in the colour vision subscale (89.8) and the lowest mean score in the driving subscale (34.0). Worse visual acuity (P<0.001), longer duration of glaucoma (P<0.001) and higher number of glaucoma medications (P<0.001) were associated with a worse composite score. Female participants and those who lived in urban areas had significantly better scores than male participants (P=0.002) and those who lived in rural areas (P=0.017), respectively. CONCLUSION: The vision-related quality-of-life in Jamaican glaucoma patients is comparable to that of glaucoma patients in the Barbados Eye Study and other international studies using the VFQ-25 questionnaire. Worse quality-of-life scores are associated with poorer visual acuity, longer duration of glaucoma, more glaucoma medications, and sociodemographic factors such as male gender and rural residence.

10 Comparison of 24×20 mm2 swept-source OCTA and fluorescein angiography for the evaluation of lesions in diabetic retinopathy

Qiao-Zhu Zeng , Si-Ying Li , Yu-Ou Yao , En-Zhong Jin , Jin-Feng Qu , Ming-Wei Zhao

2022, 15(11):1798-1805. DOI: 10.18240/ijo.2022.11.10

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AIM: To compare ultra-widefield (24×20 mm2) swept-source optical coherence tomography angiography (SS-OCTA) and fluorescein angiography (FA) in the evaluation of diabetic retinopathy (DR) lesions. METHODS: Forty-six eyes of 23 patients with treatment-naïve DR were included at Peking University People’s Hospital from September 1, 2021, until December 31, 2021, as well as 23 age and gender matched healthy controls. Quantitative assessments of DR lesions on FA and SS-OCTA (superficial capillary plexus, SCP, 24×20 mm2) were performed. RESULTS: Area of fovea avascular zone (FAZ) was larger in DR cases than controls (0.34±0.069 mm2 vs 0.287±0.108 mm2, P=0.006). In DR eyes, the mean FAZ area was 0.34±0.069 and 0.334±0.087 mm2 on SS-OCTA and FA, respectively (P=0.428), while the median FAZ perimeter was 2.382 (IQR, 2.201-2.59) and 2.333 (IQR, 2.138-2.6) mm on SS-OCTA and FA images (P=0.733). There was no significant difference in the size of the non-perfusion area (NPA) between the images on SS-OCTA and FA (12.389, IQR 4.96-28.3 and 11.125, IQR 5-28.31 mm2, P=0.197). The median total microaneurysm (MA) count was 35 (IQR, 19-46) and 73 (IQR, 43-93) on SS-OCTA and FA (P<0.001), respectively. No significant difference in intra-retinal microvascular abnormality (IRMA) and neovascularization (NV) count was found between the two techniques. The intraclass coefficient (ICCs) of all the parameters above indicated stable repeatability. CONCLUSION: Ultra-widefield SS-OCTA represents a reliable, noninvasive, and quantitative imaging technique in the assessment of microvasculature in DR, which offers a potential substitute for FA in DR evaluation.

11 Negative effects of enlarging internal limiting membrane peeling for idiopathic macular hole surgery

Ze-Tong Nie , Bo-Shi Liu , Yong Wang , Qiong Chen , Jiao-Ting Wei , Meng Yang , Shao-Fang Pang , Xiao-Rong Li , Bo-Jie Hu

2022, 15(11):1806-1813. DOI: 10.18240/ijo.2022.11.11

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AIM: To observe the effects of the different extents of internal limiting membrane (ILM) peeling on the surgical success and anatomical and functional outcomes of idiopathic macular hole (IMH). METHODS: In this retrospective cohort study, 36 patients were reviewed and divided into two groups according to the extent of ILM peeling: group A (18 patients), with the peeling area within one-half of the optic disc macular distance as the radius; group B (18 patients), with the peeling area larger than that of group A but did not exceed the optic disc macular distance as the radius. The main outcomes included the best corrected visual acuity (BCVA), light-adaptive electroretinography, macular hole (MH) closure rate, central macular thickness (CMT), retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness [nine regions based on the Early Treatment of Diabetic Retinopathy Study (ETDRS) ring] before and 1, 3, and 6mo after surgery. RESULTS: The closure rate was 94.4% (17/18) both in groups A and B. The BCVA in both groups improved significantly compared with the preoperative values, but there was no difference between the two groups. The b-wave amplitude of the electroretinogram analysis was significantly improved in both groups compared to that of the preoperative period, with a greater increase in group A than in group B at 6mo (P=0.017). The CMT in both groups gradually decreased after surgery, and there was no difference between the two groups. The RNFL thickness of the temporal outer ring region in group B was significantly lower than that in group A at 3 and 6mo after surgery (P=0.010, 0.032). The GCC thickness of the temporal outer ring region in group B was significantly lower than that in group A at 6mo after surgery (P=0.038). CONCLUSION: Enlarging the extent of ILM peeling doesn’t affect the IMH closure rate and visual acuity recovery, but the greater the extent of peeling, the greater the damage to the inner retinal structures.

12 Real-world outcomes of anti-vascular endothelial growth factor therapy for retinal vascular vein occlusion in Tibet, China

Xue-Mei Zhu , Ying-Ying Yu , Sina Zhuoga , Xiao Dawa , Yong-Kang Zhou , Ouzhu Wangmu , Deji Yangzong , Fang An , Heng Miao , Ming-Wei Zhao

2022, 15(11):1814-1820. DOI: 10.18240/ijo.2022.11.12

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AIM: To evaluate the outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents for patients with retinal vein occlusion (RVO) related-macular edema (ME) in Tibetan. METHODS: A retrospective, observational, single-center study. The demographic and clinical data of 90 RVO Tibetan patients (93 eyes) treated with either ranibizumab or conbercept in Tibet Autonomous Region People’s Hospital from Jan 2018 to December 2019 were collected. RESULTS: The mean patient age was 56.8±10.6y, 45 (50%) of them were female. The mean living altitude was 3867.8±567.9 m. At the last visit, the best-corrected visual acuity (BCVA) significantly increased (52.2±21.8 letters) in comparison with the baseline (38.2±24.1 letters, P<0.001); while the central retinal thickness (CRT) significantly reduced (245.5±147.6 μm) in comparison with the baseline (504.1±165.2 μm, P<0.001). The 43.0% of the eyes gained ≥15 letters, 60.2% of the eyes gained ≥10 letters, and 78.5% of the eyes gained ≥5 letters. No vision loss was noted in 92.5% of the eyes, 4 eyes lost more than 10 letters during follow-up period. The mean number of injections was 2.4±1.8. No severe ocular or systemic adverse events related to either the drug or injection were noted. CONCLUSION: Anti-VEGF therapy is effective and safe in Tibetan patients for the treatment of RVO related ME.

13 Effect of FFP2/N95 facemask wear on retinal and choroidal thickness profile in healthy subjects

Betul Onal Gunay , Irfan Akalin , Ahmet Kalkisim , Cenap Mahmut Esenulku , Elif Betul Turkoglu

2022, 15(11):1821-1828. DOI: 10.18240/ijo.2022.11.13

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AIM: To investigate the influence of non-oil 95 (N95)/filtering facepiece 2 (FFP2) facemask wear on retinal thickness, choroidal thickness (CT), retinal nerve fiber layer thickness (RNFLT), and ganglion cell layer thickness (GCLT) in healthy subjects. METHODS: In this prospective study, 53 healthy participants who used FFP2/N95 facemask were enrolled. Participants underwent optical coherence tomography imaging before and at 1 and 4h following FFP2/N95 facemask wear. The last imaging session was performed 1h after FFP2/N95 removal. Retinal thickness, CT, RNFLT, and GCLT were assessed at each session. Vital parameters were also assessed. RESULTS: The pulse rate of the subjects significantly decreased at 1 and 4h compared to baseline values (P<0.05). No significant changes in retinal thickness, RNFLT, and GCLT were observed in the study. CT profile showed a significant increase at all measured locations except 1-mm temporal, 1-mm inferior and 2-mm inferior points following FFP2/N95 wear which turned to baseline values after FFP2/N95 removal. Pulse rate and CT changes at 4h were significantly correlated (P<0.05). CONCLUSION: Parasympathetic activation during FFP2/N95 facemask wear might have a role on elevated CT measurements in healthy individuals by virtue of increased choroidal blood flow.

14 Factors associated with diabetic retinopathy screening and regular eye checkup practice among diabetic patients attending Felege Hiwot Specialized Hospital

Sofonias Addis Fekadu , Mohamed Abdu Seid , Yonas Akalu , Yibeltal Yismaw Gela , Mengistie Diress , Mihret Getnet , Baye Dagnew , Yitayeh Belsti

2022, 15(11):1829-1836. DOI: 10.18240/ijo.2022.11.14

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AIM: To identify associated factors of diabetic retinopathy (DR) screening and ey e check-up practice among diabetes mellitus (DM) patients attending Felege Hiwot Specialized Hospital. METHODS: An institution-based cross-sectional study was applied from October 4, 2019 to January 12, 2020 at Felege Hiwot Specialized Hospital. A systematic random sampling technique was used to recruit participants and an interviewer-administered questionnaire was employed to collect the data. The collected data were entered into Epi Info version 7 and transposed to SPSS version 24 for statistical analysis. Descriptive statistics were executed and associated factors were identified using binary logistic regression. The strength of association between the independent and the outcome variable was determined using an adjusted odds ratio (AOR) with 95% confidence interval (CI). RESULTS: Four hundred and six participants partake with a response rate of 95.7% and a mean age of 47±11.5y. The magnitude of DR screening was 308 (75.9%, 95%CI: 71.5%, 79.8%). Higher educational level (AOR=3.25; 95%CI: 1.40, 8.78), good knowledge of DR (AOR=2.50; 95%CI: 1.55, 4.46), and family history of DM (AOR=2.15; 95%CI: 1.41, 3.85) were significantly associated with DR screening. On the other side, rural residence [AOR=3.11 (1.89, 5.02)] and undesirable attitudes toward DR [AOR=5.65 (3.14, 8.76)] were significantly associated with poor regular eye checkup practice. CONCLUSION: Most of the participants are screened for DR. Higher education, family history, and good knowledge are associated with DR screening. In addition, rural residence and undesirable attitudes toward DR are associated with regular eye checkup practice.

15 Changes on optical coherence tomography angiography and fluorescein angiography in eyes with neovascular age-related macular degeneration

So Min Ahn , Mihyun Choi , Cheolmin Yun , Seong-Woo Kim , Jaeryung Oh

2022, 15(11):1837-1844. DOI: 10.18240/ijo.2022.11.15

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AIM: To evaluate the changes on optical coherence tomography angiography (OCTA) and fluorescein angiography (FA) and their correlation in neovascular age-related macular degeneration (nAMD) before and after intravitreal aflibercept injections (IAIs). METHODS: In 43 treatment-naïve patients with nAMD, choroidal neovascularization (CNV) in OCTA were morphologically and quantitatively analyzed before and after IAIs to determine whether they are correlated with leakage on FA or not. By combining CNV in OCTA and leakage in FA, lesions were characterized as three types: L+C+ (with both CNV and leakage), L-C+ (with CNV but without leakage), or L+C- lesion (with leakage outside CNV). RESULTS: Before IAI, while 27 eyes had L+C+ lesion only, 16 eyes had both L+C+ and L-C+ lesions simultaneously. Tiny capillaries and anastomosis in CNV were more developed in L+C+ lesion, at 86.0% and 58.1%, respectively, relative to 9.3% and 9.3% in L-C+ lesions (P<0.001). After IAIs in 33 eyes, tiny capillaries and anastomosis were decreased in the lesions with cessation of leakage on FA (P<0.001 and P=0.001, respectively). In quantitative analysis, neovascularization length and numbers of junctions and endpoints were also significantly decreased. CONCLUSION: Leakage on FA is associated with CNV morphology in OCTA and remained so after IAIs. Therefore, by carefully assessing the morphological and quantitative changes of CNV in OCTA before and after treatment, activity of nAMD is expected even though CNV on OCTA is not completely matched with fluorescein leakage.

16 Clinical efficacy of botulinum toxin type A on acute acquired comitant esotropia

Xiao-Qi Huang , Xue-Min Hu , Yi-Jia Zhao , Mei-Hong Ye , Bei-Xi Yi , Lian-Hong Zhou

2022, 15(11):1845-1851. DOI: 10.18240/ijo.2022.11.16

[Abstract](497) [HTML](0) [PDF 609.44 K](678)

Abstract:
AIM: To investigate the effects of micro-injection of botulinum toxin A (BTXA) on acute acquired comitant esotropia (AACE). METHODS: A total of 33 AACE patients who underwent BTXA micro-injection at Renmin Hospital of Wuhan University from September 1st, 2019 to July 1st, 2021 were retrospective analyzed. Esotropia, eye alignment, stereopsis, and complications were examined at baseline (except complications), 1wk, 1, 3, and 6mo after injection. RESULTS: The average angle of deviation before injection was (+20.24±6.80)Δ at near and (+24.76±6.43)Δ at distance, while (+5.15±5.85)Δ at near and (+7.30±6.17)Δ at distance 6mo after treatment (P<0.05). Six months after injection, the stereopsis of patients had improved. The number of patients having no stereopsis (>800 seconds of arc) decreased from 11 to 3. The number of patients having peripheral stereopsis (300-800 seconds of arc), macular stereopsis (70-200 seconds of arc) and central concave stereopsis (≤60 seconds of arc) increased from 10 to 11, 10 to 12, and 2 to 7, respectively. At the follow-ups at 1wk, 1, 3, and 6mo after injection, success rates were 96.97%, 96.97%, 93.94% and 87.88%, respectively. One week after injection, two patients (6.07%) showed subconjunctival hemorrhage; three patients (9.09%) showed limited eye movement and one patient (3.03%) showed mild vertical strabismus. All the symptoms disappeared by the final follow-up. CONCLUSION: Micro-injection of BTXA can reduce diplopia and improve binocular vision function of AACE patients. Furthermore, the operation is relatively safe with few complications, making it an ideal treatment modality for AACE.

17 Oculoplastic publication trends in general ophthalmology journals

Jean-Paul Dray , Nur Khatib , Eric Souied , Peerooz Saeed , Guy Ben Simon , Juliana Gildener-Leapman , Ofira Zloto

2022, 15(11):1852-1856. DOI: 10.18240/ijo.2022.11.17

[Abstract](398) [HTML](0) [PDF 1.36 M](548)

Abstract:
AIM: To examine the publication trend of oculoplastic articles throughout the last decade in general ophthalmology journals. METHODS: A review of all abstracts published between January 2010 to December 2019 in general, clinical ophthalmic journals was conducted. Articles that were categorized as original articles in general and clinical journals were included in the study. RESULTS: Totally 10 281 abstracts were included. Of them 465 (4.5%) were oculoplastic publications. The mean number of annual-publications was 46.5 and the mean annual-rate of oculoplastic publications was 4.51%. A significant decreasing trend in the number of oculoplastic publication in the last decade was found (P<0.01, R2=0.770). However, there was no significant change in the annual-rate of oculoplastic publications during the last decade (P=0.191, R2=0.203). From the 465 oculoplastic articles: 179 (38.5%) were articles about eyelid diseases, 160 (34.40%) were about orbit diseases, 92 (19.80%) were about lacrimal diseases and 34 (7.30%) were about thyroid eye disease (TED). A significant decreasing trends in the number of orbital and eyelids publications were found (P<0.01, P<0.01). However, there were no significant changes in the annual-rate of orbital, eyelids, TED and lacrimal-diseases publications throughout the last decade. CONCLUSION: Oculoplastic subspecialty deals with a wide range of pathologies in different ages. However, less than 5% of the articles in general, clinical, high impact factor ophthalmology journals are about oculoplastic diseases. One of the best way for ophthalmologists from different subspecilties, nowadays, to be updated, is to read high-impact-factor, general ophthalmology journals. Therefore, it is important that those journals will include articles about breakthroughs in oculoplastic.

18 Insights on the possibility of SARS-CoV-2 transmission through the eyes

Rui Zhu , Zi-Yan Yu , Lin Han

2022, 15(11):1857-1863. DOI: 10.18240/ijo.2022.11.18

[Abstract](460) [HTML](0) [PDF 428.05 K](612)

Abstract:
A novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or 2019-nCOV), causing coronavirus disease 2019 (COVID-19), has rapidly spread to most countries and regions worldwide since it broke out at the end of 2019. Epidemic of the virus produces a tremendous pressure on the global health systems. With progressive insight into SARS-CoV-2, the role of eye tissue has attracted wide attention in the spread of COVID-19. Whether SARS-CoV-2 can enter the human body through eyes and cause infection? The fact that unprotected exposure of the eyes to 2019-nCoV might have allowed the virus to infect the body implies that 2019-nCOV can invade eye tissue and set foot in organism. Facing the severe challenge of preventing spread of the COVID-19, combined with the high-risk environment of ophthalmology, it is crucial to investigate ocular tropism of coronavirus. This paper explores the possibility of coronavirus transmission through the eye from aspects of probable mechanisms, clinical cases, detection of coronavirus; and puts forward precautions for ophthalmologists and nurses. Consequently, this review reveals our understanding of ocular tropism of coronavirus and contributes to determining risk of ocular transmission, raising awareness of necessary eye protection among medical workers and reducing further prevalence of SARS-CoV-2.

19 Gastrointestinal microbiome and primary Sjögren’s syndrome: a review of the literature and conclusions

Yu-Feng Yao , Mei-Ying Wang , Xiao-Yan Dou

2022, 15(11):1864-1872. DOI: 10.18240/ijo.2022.11.19

[Abstract](625) [HTML](0) [PDF 583.97 K](739)

Abstract:
The recognition of the profound impact of the human gastrointestinal microbiome (GM) on human autoimmune diseases has gradually increased thanks to deeper research efforts. As a systemic autoimmune disease, primary Sjögren’s syndrome (pSS) cannot be completely cured. Human studies have revealed that GM species and diversity are altered in patients with pSS compared with healthy individuals. Animal studies have provided possible mechanisms for the association between pSS and GM. The potential role of GM in pSS is exerted through several mechanisms. GM dysbiosis leads to increased intestinal permeability, which increases the risk of GM antigen exposure and activates specific autoreactive T lymphocytes via “molecular mimicry”. In addition, GM antigen exposure and intestinal immune tolerance loss caused by GM dysbiosis together induce chronic local gut mucosal inflammation, which deteriorates to systemic chronic non-specific inflammation with the circulation of pro-inflammatory lymphocytes and cytokines. These factors eventually activate autoreactive B lymphocytes and lead to pSS. If GM plays a key role in the pathogenesis of pSS, clarifying the underlying mechanisms will be helpful for the development of new therapies targeting GM for dry eye associated with pSS. This review summarizes the latest knowledge about the relationship between GM and pSS, with the aim of contributing to future research and to the development of new clinical applications.