Volume 16,Issue 5,2023 Table of Contents

1 Analysis of retinal arteriolar and venular parameters in primary open angle glaucoma

Jia-Peng Wang , Mei-Ting Yu , Bo-Lun Xu , Jin-Ping Hua , Li-Gang Jiang , Jian-Tao Wang , Wei-Hua Yang , Yu-Hua Tong

2023, 16(5):671-679. DOI: 10.18240/ijo.2023.05.01

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Abstract:
AIM: To measure the retinal vessels of primary open angle glaucoma (POAG) patients on spectral domain optical coherence tomography (SD-OCT) with a full-width at half-maximum (FWHM) algorithm to better explore their structural changes in the pathogenesis of POAG. METHODS: In this retrospective case-control study, the right eyes of 32 patients with POAG and 30 healthy individuals were routinely selected. Images of the supratemporal and infratemporal retinal vessels in the B zones were obtained by SD-OCT, and the edges of the vessels were identified by the FWHM method. The internal and external diameters, wall thickness (WT), wall cross-sectional area (WCSA) and wall-to-lumen ratio (WLR) of the blood vessels were studied. RESULTS: Compared with the healthy control group, the POAG group showed a significantly reduced retinal arteriolar outer diameter (RAOD), retinal arteriolar lumen diameter (RALD) and WSCA in the supratemporal (124.22±12.42 vs 138.32±10.73 µm, 96.09±11.09 vs 108.53±9.89 µm, and 4762.02±913.51 vs 5785.75±1148.28 µm2, respectively, all P<0.05) and infratemporal regions (125.01±15.55 vs 141.57±10.77 µm, 96.27±13.29 vs 110.83±10.99 µm, and 4925.56±1302.88 vs 6087.78±1061.55 µm2, all P<0.05). The arteriolar WT and WLR were not significantly different between the POAG and control groups, nor were the retinal venular outer diameter (RVOD), retinal venular lumen diameter (RVLD) or venular WT in the supratemporal or infratemporal region. There was a positive correlation between the arteriolar parameters and visual function. CONCLUSION: In POAG, narrowing of the supratemporal and infratemporal arterioles and a significant reduction in the WSCA is observed, while the arteriolar WT and WLR do not change. Among the venular parameters, the external diameter, internal diameter, WT, WLR, and WSCA of the venules are not affected.

2 Identification and functional analyses of a novel FOXL2 pathogenic variant causing blepharophimosis, ptosis, and epicanthus inversus syndrome

Yu-Cheng Yan , Lu Zhou , Jin-Cai Fan

2023, 16(5):680-686. DOI: 10.18240/ijo.2023.05.02

[Abstract](256) [HTML](0) [PDF 1.66 M](755)

Abstract:
AIM: To discover the molecular pathogenic basis of the blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES), and to predict the clinical subtype according to in vitro experiments, which is significant to the prognosis. METHODS: A 3-year-old sporadic female patient with typical clinical manifestations of BPES was enrolled. The coding region of forkhead box L2 (FOXL2) gene was sequenced, and the functional assays were performed in vitro by Western blotting, subcellular localization experiment, luciferase reporter assay, and quantitative real-time polymerase chain reaction. RESULTS: A novel FOXL2 point pathogenic variant (c.274G>T) was detected, resulting in a truncated protein (p.E92*). Functional studies demonstrated that the FOXL2 pathogenic variant induced the subcellular mislocalization and the abnormal transcriptional activity on promoters of the steroidogenic acute regulatory protein (StAR or STARD1) gene and the odd-skipped related 2 transcription factor (OSR2) gene. CONCLUSION: A novel pathogenic variant is identified to expand the spectrum of the known FOXL2 mutations. The in vitro experiments provide reference data and more insights to the molecular pathogenesis of BPES. The predicted high risk of ovarian insufficiency makes it significant for the patient enrolled to have further follow-up and therapy concerning female endocrinology.

3 Protective effects of ferulic acid against ionizing radiation-induced oxidative damage in rat lens through activating Nrf2 signal pathway

Yueqin Chen , Jiawei Shen , Xiaoran Zhang , Weiping Gao , Qian Cao , Feng Yan , Chunyan Xue

2023, 16(5):687-693. DOI: 10.18240/ijo.2023.05.03

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Abstract:
AIM: To examine the protection of ferulic acid (FA) against ionizing radiation (IR)-induced lens injury in rats, as well as the underlying mechanisms. METHODS: FA (50 mg/kg) was administered to rats for 4 consecutive days before they were given 10 Gy γ-radiation, as well as for 3 consecutive days afterward. Two weeks after radiation, the eye tissues were collected. Histological alterations were evaluated by hematoxylin-eosin staining. Enzyme linked immunosorbent assay (ELISA) was utilized to assess the activities of glutathione reductase (GR) and superoxide dismutase (SOD), as well as the levels of glutathione (GSH) and malondialdehyde (MDA) in the lenses. The protein and mRNA levels of Bcl-2, caspase-3, Bax, heme oxygenase-1 (HO-1), and glutamate-cysteine ligase catalytic subunit (GCLC) were quantified using Western blot and quantitative reverse transcription polymerase chain reaction, respectively. With nuclear extracts, the nuclear factor erythroid-2 related factor (Nrf2) protein expressions in the nuclei were also measured. RESULTS: Rats exposed to IR showed lens histological alterations which could be alleviated by FA. FA treatment reversed apoptosis-related markers in IR-induced lens, as evidenced by lower levels of Bax and caspase-3 and higher level of Bcl-2. Furthermore, IR induced oxidative damage manifested by decreased GSH level, increased MDA level, and decreased SOD and GR activities. FA boosted nuclear translocation of Nrf2 and increased the expressions of HO-1 and GCLC to inhibit oxidative stress, as evidenced by an increase in GSH, a decrease in MDA, and an increase in GR and SOD activities. CONCLUSION: FA may work well in preventing and treating IR-induced cataract through promoting the Nrf2 signal pathway to attenuate oxidative damage and cell apoptosis.

4 Novel homozygous ADAMTS17 missense variant in Weill-Marchesani syndrome

Na Miao , Yao Zhang , Jin-Ying Liao , Lin Zhou , Ji-Cai He , Rong-Qin Yang , Xu-Yang Liu , Li Tang

2023, 16(5):694-699. DOI: 10.18240/ijo.2023.05.04

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Abstract:
AIM: To explore the phenotype and genotype of Weill-Marchesani syndrome (WMS) in a Chinese family and review related literature. METHODS: Three WMS patients and other unaffected individuals in this family with a history of consanguineous marriage were included in this study. Medical history, comprehensive ophthalmic examinations, and systemic evaluation, as well as whole exome and Sanger sequencing of specific genomic regions, were performed. RESULTS: The three affected siblings presented with short stature, brachydactyly and ocular disorders, including very shallow anterior chamber, high myopia, microspherophakia lens subluxation with stretched zonules and glaucoma. Genetic analysis verified a homozygous missense mutation (c.2983C>T: p. Arg995Trp) in ADAMTS17, which was correlated with the diseases in this family, indicating an autosomal recessive inherited manner of WMS. This review aims to summarize the mutation sites of WMS genes, so as to prevent the disease and better guide clinical diagnosis and treatment. CONCLUSION: A novel homozygous missense variant of ADAMTS17 is identified in a WMS family with a history of consanguineous marriage. Our study expands the range of mutations associated with WMS and deepens our understanding of pathology in disease associated with ADAMTS17 variants.

5 Cost analysis of childhood glaucoma surgeries using the US Medicaire allowable costs

Abdelrahman M. Elhusseiny , Mohamed M. Khodeiry , Nicolas A. Yannuzzi , Ta C. Chang , Richard K. Lee , William E. Smiddy

2023, 16(5):700-704. DOI: 10.18240/ijo.2023.05.05

[Abstract](354) [HTML](0) [PDF 742.08 K](634)

Abstract:
AIM: To analyze and calculate the relative cost of various childhood glaucoma surgical interventions per mm Hg intraocular pressure (IOP) reduction ($/mm Hg). METHODS: Representative index studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for each surgical intervention in childhood glaucoma. A US perspective was adopted, using Medicare allowable costs to calculate cost/mm Hg IOP reduction ($/mm Hg) at 1y postoperatively. RESULTS: At 1y postoperatively, the cost/mm Hg IOP reduction was $226/mm Hg for microcatheter-assisted circumferential trabeculotomy, $284/mm Hg for cyclophotocoagulation, $288/mm Hg for conventional ab-externo trabeculotomy, $338/mm Hg for Ahmed glaucoma valve, $350/mm Hg for Baerveldt glaucoma implant, $351/mm Hg for goniotomy, and $400/mm Hg for trabeculectomy. CONCLUSION: Microcatheter-assisted circumferential trabeculotomy is the most cost-efficient surgical method to lower IOP in childhood glaucoma, while trabeculectomy is the least cost-efficient surgical method.

6 Predicting the prognosis of primary orbital lymphoma by clinical characteristics and imaging features

Jian-Bo Zhu , Bin Li , Hong-Mei Zhang , Ning-Li Wang

2023, 16(5):705-711. DOI: 10.18240/ijo.2023.05.06

[Abstract](289) [HTML](0) [PDF 2.20 M](599)

Abstract:
AIM: To analyze the 5-year disease-free survival (DFS) of primary orbital lymphoma (POL) by clinical characteristics and imaging features. METHODS: A total of 72 patients, 43 males and 29 females, with histologically confirmed POL, were retrospectively recruited between January 2012 and May 2017. The information on clinical characteristics, imaging features, and 5-year DFS was obtained. Univariate and multivariate forward logistic regression analyses were used to identify the variables significantly associated with 5-year DFS. Kaplan-Meier was applied for survival analysis. RESULTS: Univariate analysis revealed that uni- or bilateral orbital involvement, single or multiple lesions, treatment methods, and contrast enhancement pattern on images were significant for 5-year DFS (P=0.022, 0.042, <0.001, and 0.028, respectively), while in multivariate logistic regression analysis, only uni- or bilateral orbital involvement, treatment methods and contrast enhancement pattern on images were significant (r=0.453, 0.897, and 0.556, P=0.038, <0.001 and 0.022, respectively). The survival curves for DFS were obtained. CONCLUSION: The majority of POL are B-cell lymphomas. Unilateral orbital involvement, homogeneous contrast enhancement on images, and the appropriate treatment schemes result to be significant factors for a good prognosis for POL.

7 Guidelines from an expert panel for the management of diabetic macular edema in the Malaysian population

Nor Fariza Ngah , Nor Asiah Muhamad , Shelina Oli Mohamed , Roslin Azni Abdul Aziz , Nur Hasnah Ma’amor , Nor Azita Ahmad Tarmidzi , Hanizasurana Hashim , Hamisah Ishak , Wan Norliza Wan Muda , Rosiah Muda , Azian Adnan , Rafidah Md Saleh , Wong Hon Seng , Nurfahzura Mohd Jamil , Tara Mary George , Adrian Koh

2023, 16(5):712-720. DOI: 10.18240/ijo.2023.05.07

[Abstract](497) [HTML](0) [PDF 2.39 M](719)

Abstract:
AIM: To derive a Malaysia guideline and consensus as part of the Malaysia Retina Group’s efforts for diagnosis, treatment, and best practices of diabetic macular edema (DME). The experts’ panel suggests that the treatment algorithm to be divided into groups according to involvement the central macula. The purpose of DME therapy is to improve edema and achieve the best visual results with the least amount of treatment load. METHODS: On two different occasions, a panel of 14 retinal specialists from Malaysia, together with an external expert, responded to a questionnaire on management of DME. A consensus was sought by voting after compiling, analyzing and discussion on first-phase replies on the round table discussion. A recommendation was deemed to have attained consensus when 12 out of the 14 panellists (85%) agreed with it. RESULTS: The terms target response, adequate response, nonresponse, and inadequate response were developed when the DME patients’ treatment responses were first characterized. The panelists reached agreement on a number of DME treatment-related issues, including the need to classify patients prior to treatment, first-line treatment options, the right time to switch between treatment modalities, and side effects associated with steroids. From this agreement, recommendations were derived and a treatment algorithm was created. CONCLUSION: A detail and comprehensive treatment algorithm by Malaysia Retina Group for the Malaysian population provides guidance for treatment allocation of patients with DME.

8 Analysis of postoperative ocular surface changes and intervention effect after pars plana vitrectomy in meibomian gland dysfunction dry eye patients

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

2023, 16(5):721-729. DOI: 10.18240/ijo.2023.05.08

[Abstract](447) [HTML](0) [PDF 1.74 M](698)

Abstract:
AIM: To observe ocular surface changes after phacovitrectomy in patients with mild to moderate meibomian gland dysfunction (MGD)-type dry eye and track clinical treatment response using a Keratograph 5M and a LipiView interferometer. METHODS: Forty cases were randomized into control group A and treatment group B; the latter received meibomian gland treatment 3d before phacovitrectomy and sodium hyaluronate before and after surgery. The average non-invasive tear film break-up time (NITBUTav), first non-invasive tear film break-up time (NITBUTf), non-invasive measured tear meniscus height (NTMH), meibomian gland loss (MGL), lipid layer thickness (LLT) and partial blink rate (PBR) were measured preoperatively and 1wk, 1 and 3mo postoperatively. RESULTS: The NITBUTav values of group A at 1wk (4.38±0.47), 1mo (6.76±0.70), and 3mo (7.25±0.68) were significantly lower than those of group B (7.45±0.78, 10.46±0.97, and 11.31±0.89; P=0.002, 0.004, and 0.001, respectively). The NTMH values of group B at 1wk (0.20±0.01) and 1mo (0.22±0.01) were markedly higher than those of group A (0.15±0.01 and 0.15±0.01; P=0.008 and P<0.001, respectively); however, there was no difference at 3mo. The LLT of group B at 3mo [91.5 (76.25-100.00)] significantly exceeded that of group A [65.00 (54.50-91.25), P=0.017]. No obvious intergroup difference was found in MGL or PBR (P>0.05). CONCLUSION: Mild to moderate MGD dry eye worsens in the short term after phacovitrectomy. Preoperative cleaning, hot compresses, and meibomian gland massage as well as preoperative and postoperative sodium hyaluronate promote the rapid recovery of tear film stability.

9 A sutureless technique for securing leaking sclerotomies with viscoelastic substances in 23-gauge microincision vitrectomy surgery

Meng Li , Quan-Yong Yi , Jing-Hai Mao , Yan-Hong Liao , Yan-Yan Wang , Qin-Kang Lu , Yan Gong

2023, 16(5):730-735. DOI: 10.18240/ijo.2023.05.09

[Abstract](329) [HTML](0) [PDF 1012.06 K](567)

Abstract:
AIM: To introduce and evaluate the clinical efficacy of a new technique, the use of viscoelastic substances (VS) to close leaking sclerotomy in 23G microincision vitrectomy, and to observe its effect on the visual acuity and intraocular pressure (IOP) of patients. METHODS: Patients who underwent 23G vitrectomy in Ningbo Eye Hospital before the use of VS technique (June 2019 to September 2020) and after the use of VS technique (October 2020 to December 2021) were selected as the subjects of this study. The above cases underwent operation by the same surgeon and were retrospectively analyzed. VS technique was used as the alternative to suturing, in which a small amount of VS was injected at the leaking sclerotomy and then gently massaged to confirm leaking sclerotomy closure. RESULTS: A total of 174 eyes were covered in the study, including 84 eyes in the control group (before the use of VS technique) and 90 eyes in the VS technique group. The number of eyes that needed to be sutured decreased considerably from 42.9% in the control group to 3.3% in the VS technique group, and the proportion of subconjunctival hemorrhage at 1-2d after surgery decreased remarkably from 35.7% in the control group to 2.2% in the VS technique group. No substantial differences in the incidence of mean IOP and low IOP were found between 1-2 and 3-20d after surgery in the VS technique group. No major complications associated with VS technique were identified during the study. CONCLUSION: In 23G microincision vitrectomy, VS technique is a safe, simple, and effective method to close leaking sclerotomy.

10 Flapless one-knot suture: a novel surgical technique for transscleral fixation of C-loop intraocular lenses

Qing-Qing Long , Bao-Jiang Li

2023, 16(5):736-742. DOI: 10.18240/ijo.2023.05.10

[Abstract](317) [HTML](0) [PDF 1.57 M](555)

Abstract:
AIM: To describe a novel suture approach for transscleral fixation of C-loop intraocular lenses (IOL) and to compare the surgical outcomes with the four-haptics posterior chamber (PC)-IOL technique. METHODS: We retrospectively analyzed 16 eyes of 16 patients who underwent transscleral fixation of C-loop PC-IOLs using a flapless one-knot suture technique, which were followed up for longer than 17mo. In this technique, the capsulorless IOL was suspended using a single suture for transscleral fixation of four feet. Then we compared its surgical outcomes and complications with the four-haptics PC-IOLs using the Student’s t test and Chi-square test. RESULTS: Sixteen patients of 16 eyes with a mean age of 58.3±10.1y (42-76y) who received transscleral C-loop IOL implantation due to trauma, vitrectomy, or cataract surgery with inadequate capsule support showed improved visual acuity. The difference was not significant between two IOLs except the surgery time (P>0.05). The mean operation times of C-loop IOL surgery was 24.1±1.83min and 31.3±4.47min of the four-haptics PC-IOL method (P<0.0001). In the C-loop IOLs group, there was statistical difference between the preoperative and the postoperative UCVA (logMAR, 1.20±0.50 vs 0.57±0.32, P=0.0003). There was no statistical difference between the preoperative and the postoperative BCVA (logMAR, 0.66±0.46 vs 0.40±0.23, P=0.056). However, there was no statistically significant difference in postoperative UCVA and BCVA between the two IOLs (P>0.05). We did not detect any optic capture, IOL decentration or dislocation, suture exposed, or cystoid macular edema in patients underwent C-loop IOLs surgery. CONCLUSION: The novel flapless one-knot suture technique for transscleral fixation of C-loop IOL is a simple, reliable, and stable technique.

11 Assessment of iris volume in glaucoma patients with type 2 diabetes mellitus by AS-OCT

Ying Su , Qing-Shu Ge , Zong-Yi Li , Qian-Wen Bu , Die Hu , Long-Fang Zhou , Xiao-Jing Pan

2023, 16(5):743-747. DOI: 10.18240/ijo.2023.05.11

[Abstract](669) [HTML](0) [PDF 824.90 K](659)

Abstract:
AIM: To examine the change of iris volume measured by CASIA2 anterior segment optical coherence tomography (AS-OCT) in glaucoma patients with or without type 2 diabetes mellitus (T2DM) and explore if there is a correlation between hemoglobin A1c (HbA1c) level and iris volume. METHODS: In a cross-sectional study, 72 patients (115 eyes) were divided into two groups: primary open angle glaucoma (POAG) group (55 eyes) and primary angle-closure glaucoma (PACG) group (60 eyes). Patients in each group were separately classified into patients with or without T2DM. Iris volume and glycosylated HbA1c level were measured and analyzed. RESULTS: In the PACG group, diabetic patients’ iris volume was significantly lower than those of non-diabetics (P=0.02), and there was a significant correlation between iris volume and HbA1c level in the PACG group (r=-0.26, P=0.04). However, diabetic POAG patients’ iris volume was noticeably higher than those of non-diabetics (P=0.01), and there was a significant correlation between HbA1c level and iris volume (r=0.32, P=0.02). CONCLUSION: Diabetes mellitus impact iris volume size, as seen by increased iris volume in the POAG group and decreased iris volume in the PACG group. In addition, iris volume is significantly correlated with HbA1c level in glaucoma patients. These findings imply that T2DM may compromise iris ultrastructure in glaucoma patients.

12 Microstructural morphology and visual acuity outcome in eyes with epiretinal membrane before, during, and after membrane peeling in intraoperative optical coherence tomography assisted macular surgery

Melanie Weschta , Moritz Pettenkofer , Julian E. Klaas , Nikolaus Feucht , Chris P. Lohmann , Mathias Maier

2023, 16(5):748-754. DOI: 10.18240/ijo.2023.05.12

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Abstract:
AIM: To measure the difference of intraoperative central macular thickness (CMT) before, during, and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity (BCVA) outcome and postoperative CMT development. METHODS: A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed. Videos with intraoperative optical coherence tomography (OCT) were recorded. Difference of intraoperative CMT before, during, and after peeling was measured. Pre- and postoperatively obtained BCVA and spectral-domain OCT images were analyzed. RESULTS: Mean age of the patients was 70±8.13y (range 46-86y). Mean baseline BCVA was 0.49±0.27 logMAR (range 0.1-1.3). Three and six months postoperatively the mean BCVA was 0.36±0.25 (P=0.01 vs baseline) and 0.38±0.35 (P=0.08 vs baseline) logMAR respectively. Mean stretch of the macula during surgery was 29% from baseline (range 2%-159%). Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery (r=-0.06, P=0.72). However, extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis (r=-0.43, P<0.01) and 1 mm nasal and temporal from the fovea (r=-0.37, P=0.02 and r=-0.50, P<0.01 respectively) 3mo postoperatively. CONCLUSION: The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness, though there is no correlation with visual acuity development within the first 6mo postoperatively.

13 Clinical and multimodal imaging features of acute macular neuroretinopathy lesions following recent SARS-CoV-2 infection

Yang-Chen Liu , Bin Wu , Yan Wang , Song Chen

2023, 16(5):755-761. DOI: 10.18240/ijo.2023.05.13

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Abstract:
AIM: To describe the clinical characteristics of eyes using multimodal imaging features with acute macular neuroretinopathy (AMN) lesions following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: Retrospective case series study. From December 18, 2022 to February 14, 2023, previously healthy cases within 1-week infection with SARS-CoV-2 and examined at Tianjin Eye Hospital to confirm the diagnosis of AMN were included in the study. Totally 5 males and 9 females [mean age: 29.93±10.32 (16-49)y] were presented for reduced vision, with or without blurred vision. All patients underwent best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscopy, indirect fundoscopy. Simultaneously, multimodal imagings fundus photography (45° or 200° field of view) was performed in 7 cases (14 eyes). Near infrared (NIR) fundus photography was performed in 9 cases (18 eyes), optical coherence tomography (OCT) in 5 cases (10 eyes), optical coherence tomography angiography (OCTA) in 9 cases (18 eyes), and fundus fluorescence angiography (FFA) in 3 cases (6 eyes). Visual field was performed in 1 case (2 eyes). RESULTS: Multimodal imaging findings data from 14 patients with AMN were reviewed. All eyes demonstrated different extent hyperreflective lesions at the level of the inner nuclear layer and/or outer plexus layer on OCT or OCTA. Fundus photography (45° or 200° field of view) showed irregular hypo-reflective lesion around the fovea in 7 cases (14 eyes). OCTA demonstrated that the superficial retinal capillary plexus (SCP) vascular density, deep capillary plexus (DCP) vascular density and choriocapillaris (CC) vascular density was reduced in 9 case (18 eyes). Among the follow-up cases (2 cases), vascular density increased in 1 case with elevated BCVA; another case has vascular density decrease in one eye and basically unchanged in other eye. En face images of the ellipsoidal zone and interdigitation zone injury showed a low wedge-shaped reflection contour appearance. NIR image mainly show the absence of the outer retinal interdigitation zone in AMN. No abnormal fluorescence was observed in FFA. Corresponding partial defect of the visual field were visualized via perimeter in one case. CONCLUSION: The morbidity of SARS-CoV-2 infection with AMN is increased. Ophthalmologists should be aware of the possible, albeit rare, AMN after SARS-CoV-2 infection and focus on multimodal imaging features. OCT, OCTA, and infrared fundus phase are proved to be valuable tools for detection of AMN in patients with SARS-CoV-2.

14 Quantitative study of peripapillary retinal nerve fiber layer thickness and peripapillary vessel density in patients with different stages of Parkinson’s disease

Ting-Yu Yang , Tian-Qi Zhang , Lai-Qing Xie , Ying Zhang , Shi-Mei Liu , Xin-Wei Zeng , Wei-Feng Luo , Guo-Xu Xu

2023, 16(5):762-769. DOI: 10.18240/ijo.2023.05.14

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Abstract:
AIM: To observe the changes in the thickness of peripapillary retinal nerve fiber layer (pRNFL) and peripapillary vessel density (pVD) in patients with different stages of Parkinson’s disease (PD). METHODS: Totally 47 patients (47 eyes) with primary PD were divided into the mild group and the moderate-to-severe group according to Hoehn & Yahr (H&Y) stage. Among them, there were 27 cases (27 eyes) in mild group and 20 cases (20 eyes) in moderate-to-severe group. And 20 cases (20 eyes) who were included in the control group were healthy people who came to our hospital for health screening at the same time. All participants underwent optical coherence tomography angiography (OCTA) examinations. The pRNFL thickness, total vessel density (tVD) and capillary vessel density (cVD) of the optic disc in average, superior half, inferior half, superior nasal (SN), nasal superior (NS), nasal inferior (NI), inferior nasal (IN), inferior temporal (IT), temporal inferior (TI), temporal superior (TS), and superior temporal (ST) were measured. One-way ANOVA was used to compare the differences of optic disc parameters among the three groups, and Pearson and Spearman correlations were used to analyze the correlation between pRNFL, pVD and the disease duration, H&Y stage and UPDRS-III score in patients with PD, respectively. RESULTS: There were significant differences in pRNFL thickness in average, superior half, inferior half, SN, NS, IN, IT and ST quadrants among the three groups (P<0.05). In PD group, the pRNFL thickness in average, superior half, inferior half, NS and IT quadrants were negatively correlated with H&Y stage and UPDRS-III score, respectively (P<0.05). There were statistically significant differences in the cVD of whole image, inferior half, NI and TS quadrants, the tVD of the whole image, inferior half, and peripapillary among the three groups (P<0.05). In PD group, the tVD of whole image and the cVD of NI and TS quadrants were negatively correlated with the H&Y stage, respectively (P<0.05); the cVD of TS quadrant was negatively correlated with UPDRS-III score (P<0.05). CONCLUSION: The thickness of pRNFL in PD patients is significantly decreased, and it is negatively correlated with H&Y stage and UPDRS-III score. With the increase of the severity of the disease, the pVD parameters in PD patients increase at first in the mild group, and then decrease in the moderate-to-severe group, and negatively correlate with H&Y stage and UPDRS-III score.

15 Orthokeratology with increased compression factor in adolescent myopia control: a 2-year prospective randomized clinical trial

Wen-Ting Tang , Li Zhang , Hui-Dan Zhang , Shi-Bei Li , Hao Liang

2023, 16(5):770-777. DOI: 10.18240/ijo.2023.05.15

[Abstract](448) [HTML](0) [PDF 1.35 M](758)

Abstract:
AIM: To explore the long-term efficacy, safety, and optical mechanism of orthokeratology with increased compression factor in adolescent myopia control. METHODS: A prospective, double-masked, and randomized clinical trial was performed from May 2016 to June 2020. Subjects aged between 8 and 16y, with myopia (-5.00 to -1.00 D), low astigmatism (≥-1.50 D) and anisometropia (≤1.00 D), were stratified into low (-2.75 to -1.00 D) and moderate (-5.00 to -3.00 D) myopia groups. Then they were randomly assigned to wear either increased compression factor (ICF; 1.75 D) orthokeratology or conventional compression factor (CCF; 0.75 D) orthokeratology. The data were recorded including axial length (AL), spherical equivalent (SE), best corrected visual acuity (BCVA), near visual acuity (NVA), corneal staining (using Efron grading scales), corneal hysteresis (CH), corneal resistance factor (CRF), higher-order aberrations (HOAs, expressed as root mean square, RMSh), and subfoveal choroidal thickness (SFChT) in the 2-year follow-up period. Pearson’s correlation coefficient was conducted to analyze the association between the changes in AL and RMSh, SFChT. RESULTS: At the 2-year visit, there were no statistical differences in all the parameters between the ICF group and the CCF group in low myopia subjects (P>0.05). For the moderate myopia subjects, the ICF group had shorter AL elongation (0.23±0.08 vs 0.30±0.11 mm, P=0.015), higher RMSh (1.94±0.50 vs 1.65±0.51 μm, P=0.041), and higher SFChT (279.04±35.72 vs 254.08±29.60 μm, P=0.008) than those in CCF group. The change in AL was negatively correlated with RMSh (r=-0.687, P<0.001) and SFChT (r=-0.464, P=0.013). CONCLUSION: ICF orthokeratology can control the progression of moderate myopia more effectively, which might be related to greater RMSh and SFChT.

16 Residual refractive errors in pseudophakic eyes and related factors: a population-based study

Hassan Hashemi , Alireza Jamali , Farhad Rezavn , Alireza Hashemi , Mehdi Khabazkhoob

2023, 16(5):778-786. DOI: 10.18240/ijo.2023.05.16

[Abstract](325) [HTML](0) [PDF 599.78 K](574)

Abstract:
AIM: To determine residual refractive error after cataract surgery in pseudophakic eyes and its relationship with age, sex, and axial length (AL). METHODS: In this population-based cross-sectional study, the sampling was performed on individuals aged 60y and above in Tehran, Iran using a multi-stage stratified random cluster sampling method. Pseudophakic eyes with a best-corrected visual acuity of 20/32 or better were analyzed and their refractive results were reported. RESULTS: The mean spherical equivalent (SE) refraction was -0.34±0.97 diopters (D) and the mean absolute SE was 0.72±0.74 D with a median of 0.5 D. Moreover, 32.68% (n=546, 95%CI: 30.27%-35.08%), 53.67% (n=900, 95%CI: 51.23%-56.1%), 68.99% (n=1157, 95%CI: 66.96%-71.02%), and 79.73% (n=1337, 95%CI: 77.69%-81.76%) of the eyes had a residual SE within ±0.25, ±0.50, ±0.75, and ±1.00 D of emmetropia, respectively. According to the multiple logistic regression model, increasing age was associated with a statistically significant decrease in predictability for all cut points. Moreover, the predictability based on all cut points was significantly lower in individuals with an AL longer than 24.5 mm than in those with an AL between 22 to 24.5 mm. CONCLUSION: Based on the results, the accuracy of intraocular lens (IOL) power calculation is lower for those who underwent cataract surgery during the last 5y in Tehran, Iran. Among the most important influential factors, the choice of IOL or it’s power disproportionate to eye conditions and age can be mentioned.

17 Ocular manifestations of children with atopic dermatitis in Saudi Arabia

Lina Hassan Raffa , Tala Musa Roblah , Nasser Talal Balbaid , Bader Sameer Zimmo , Mahmood Jameel Showail

2023, 16(5):787-793. DOI: 10.18240/ijo.2023.05.17

[Abstract](321) [HTML](0) [PDF 561.39 K](598)

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AIM: To examine the incidence of ocular abnormalities in children with atopic dermatitis (AD) in Saudi Arabia and its association with the severity of AD. METHODS: This is a cross-sectional study on 50 children with AD who were between 5 and 16 years of age. The severity of AD was evaluated using the SCORing Atopic Dermatitis (SCORAD) index. All the children underwent slit lamp exams, visual acuity assessment, intraocular pressure measurement, and corneal topography. The children were considered to have an ophthalmic abnormality if one or more of the following signs were present: glaucoma, keratoconus suspicion, in addition to lid, conjunctival, corneal, lenticular, or retinal abnormalities. RESULTS: Based on the SCORAD severity index, 14% of children had mild AD (7/50), 38% had moderate AD (19/50), and nearly half had severe AD. More than half the children exhibited facial involvement, and half had peri-orbital signs. The mean SCORAD index was 35.75. The mean age was 10.48±3.6y, and the cohort showed a slight male predominance (54% males). Both eyes of the 50 children in the cohort were studied. Based on the ocular examinations, 92% of the patients showed ocular abnormalities: lid abnormalities (27/50) followed by keratitis (22/50). Four patients had moderate risk for keratoconus in one eye and eight patients were suspected to have keratoconus. However, SCORAD severity index was not associated with age, sex, or the number or presence of ophthalmic abnormalities. CONCLUSION: This is the first study in Saudi Arabia to evaluate the prevalence of ocular manifestations in children with AD. The results indicate that the majority of children with AD have ocular abnormalities that mainly include lid abnormalities. Based on these findings, larger scale studies are needed to affirm whether regular screening for ophthalmic abnormalities would be beneficial for children with AD in terms of early intervention and prevention of sight-threatening complications.

18 Improving myopia awareness via school-based myopia prevention health education among Chinese students

Luo-Ming Huang , Xian-Ming Fan , Yu-Hong Xie , Zhi-Yong Meng , Ting Chen , Bing-Fa Dai , Yang Yu , Zhen Zeng , Chun-Ya Zhou , Jia-Jia Lin , Yin-He Chen , Qian Wang , Jian-Min Hu

2023, 16(5):794-799. DOI: 10.18240/ijo.2023.05.18

[Abstract](421) [HTML](0) [PDF 967.66 K](817)

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AIM: To investigate the myopia awareness level, knowledge, attitude, and skills at baseline and to implement and evaluate the efficacy of myopia prevention health education among Chinese students. METHODS: A total of 1000 middle school students from 2 middle schools were invited to participate in the study, and myopia prevention health education was conducted. The students were assessed at baseline, followed by a survey. The efficacy of health education was evaluated using the self-comparison method pre- and post-health education. RESULTS: The study included 957 and 850 pre- and post-health education participants, respectively. The baseline knowledge of all respondents on myopic symptoms (87.5%), myopia is a risk of eyes (72.9%), myopia prevention (91.3%), myopia increases with age (86.7%), performing periodic eye examinations (92.8%), and one first, one foot, and one inch (84.8%) significantly increased after health education (P<0.001 for all). However, the percentage of students who still did not think it necessary to take breaks after 30-40min of continuous near work was 27.0%. The opinion that “myopia can be cured” was still present in 38.3%. CONCLUSION: Implementing school-based myopia prevention health education improves knowledge, attitudes, and skills regarding myopia among Chinese middle school students.

19 Publication trends of primary angle-closure disease during 1991-2022: a bibliometric analysis

Hai-Li Huang , Guan-Hong Wang , Kai-Di Wang , Xing-Huai Sun

2023, 16(5):800-810. DOI: 10.18240/ijo.2023.05.19

[Abstract](405) [HTML](0) [PDF 3.81 M](809)

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AIM: To perform a bibliometric analysis in the field of primary angle-closure disease (PACD) research to characterize current global trends and compare contributions from different countries, institutions, journals, and authors. METHODS: All PACD-related publications from 1991 to 2022 from the Web of Science Core Collection database were extracted. Microsoft Excel and VOSviewer were used to collect publication data, analyze publication trends, and visualize relevant results. RESULTS: A total of 1721 publications with 34 591 citations were identified. China produced the most publications (554) while ranking third in citations (8220 times). The United States contributed the most citations (12 315 times) with publications (362) ranking second. The Investigative Ophthalmology Visual Science was the most productive journal concerning PACD, and Aung Tin was the author with the highest number of publications in the field. Keywords were classified into three clusters, epidemiology and pathogenesis research, optical coherence tomography (OCT) and other imaging examinations, and glaucoma surgery treatment. Genome-wide association, susceptibility loci, OCT, and combined phacoemulsification have become new hot research topics in recent years since 2015. CONCLUSION: China, the United States, and Singapore make the most outstanding contributions in the field of PACD research. OCT, combined phacoemulsification, and gene mutation-related study, are considered the potential focus for future research.

20 Mitochondrial dysfunction in glaucomatous degeneration

Zi-Qiao Zhang , Zhi Xie , Sen-Yuan Chen , Xu Zhang

2023, 16(5):811-823. DOI: 10.18240/ijo.2023.05.20

[Abstract](711) [HTML](0) [PDF 1.39 M](1182)

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Glaucoma is a kind of optic neuropathy mainly manifested in the permanent death of retinal ganglion cells (RGCs), atrophy of the optic nerve, and loss of visual ability. The main risk factors for glaucoma consist of the pathological elevation of intraocular pressure (IOP) and aging. Although the mechanism of glaucoma remains an open question, a theory related to mitochondrial dysfunction has been emerging in the last decade. Reactive oxygen species (ROS) from the mitochondrial respiratory chain are abnormally produced as a result of mitochondrial dysfunction. Oxidative stress takes place when the cellular antioxidant system fails to remove excessive ROS promptly. Meanwhile, more and more studies show that there are other common features of mitochondrial dysfunction in glaucoma, including damage of mitochondrial DNA (mtDNA), defective mitochondrial quality control, ATP reduction, and other cellular changes, which are worth summarizing and further exploring. The purpose of this review is to explore mitochondrial dysfunction in the mechanism of glaucomatous optic neuropathy. Based on the mechanism, the existing therapeutic options are summarized, including medications, gene therapy, and red-light therapy, which are promising to provide feasible neuroprotective ideas for the treatment of glaucoma.

21 Visual function and biofeedback training of patients with central vision loss: a review

Yu Deng , Chuan-Hong Jie , Jian-Wei Wang , Yuan-Yuan Li , Zi-Qiang Liu

2023, 16(5):824-831. DOI: 10.18240/ijo.2023.05.21

[Abstract](363) [HTML](0) [PDF 414.05 K](617)

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Older individuals with macular diseases, such as age-related macular degeneration, experience central vision loss (CVL) due to degeneration of their photoreceptors and retinal cells. Patients with CVL may experience various vision impairments, including of visual acuity, fixation stability, contrast sensitivity, and stereoacuity. After CVL, most patients develop a preferred retinal locus outside the affected macular region, which serves as a new visual reference. In this review, we provide an overview of the visual function and impairment in individuals with CVL. In addition, the important role of biofeedback training on the visual function and activity of individuals with CVL is also reviewed. Accordingly, the location and development of the preferred retinal loci are discussed. Finally, this review discusses how to conduct biofeedback training to treat individuals with CVL.

22 A case of Posner-Schlossman syndrome treated by gonioscopy-assisted transluminal trabeculotomy

Xiao Tang , Jia-Jian Wu , Xue-Ning Ding , Hong-Jin He , Xiao-Qun Zhou , Yu He , Lin Jing , Liu-Zhi Zeng

2023, 16(5):832-835. DOI: 10.18240/ijo.2023.05.22

[Abstract](316) [HTML](0) [PDF 1.46 M](554)

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23 Comment on “Factors affecting single-step transepithelial photorefractive keratectomy outcome in the treatment of mild, moderate, and high myopia: a cohort study”

Suraj Kumar Chaurasiya , Vishmarika Sharma , Pradeep Agarwal

2023, 16(5):836-836. DOI: 10.18240/ijo.2023.05.23

[Abstract](194) [HTML](0) [PDF 285.96 K](515)

Abstract:

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Volume 16,Issue 5,2023 Table of Contents