Volume 17,Issue 8,2024 Table of Contents

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    • 1  Role of hsa_circ_0007482 in pterygium development: insights into proliferation, apoptosis, and clinical correlations
    Li-Yun Zhang ,  Xin Liu ,  Shuo Zheng ,  Wen-Qun Xi ,  Xue-Ping Wu ,  Dan-Yao Nie ,  Hui-Ling Hu ,  Jian-Tao Wang ,  Xin-Hua Liu ,  Jing Zhang
    2024, 17(8):1387-1395. DOI: 10.18240/ijo.2024.08.01
    [Abstract](106) [HTML](0) [PDF 1.96 M](270)
    Abstract:
    AIM: To investigate the impact of hsa_circ_0007482 on the proliferation and apoptosis of human pterygium fibroblasts (HPFs) and its correlation with the severity grades of pterygium. METHODS: Pterygium and normal conjunctival tissues were collected from the superior area of the same patient’s eye (n=33). The correlation between pterygium severity and hsa_circ_0007482 expression using quantitative reverse-transcription polymerase chain reaction (RT-qPCR) were analyzed. Three distinct siRNA sequences targeting hsa_circ_0007482, along with a negative control sequence, were transfected into HPFs. Cell proliferation was assessed using the cell counting kit-8. Expression levels of Ki67, proliferating cell nuclear antigen (PCNA), Cyclin D1, Bax, B-cell lymphoma-2 (Bcl-2), and Caspase-3 were measured via RT-qPCR. Immunofluorescence staining was employed to detect Ki67 and vimentin expressions. Apoptosis was evaluated using flow cytometry. RESULTS: Hsa_circ_0007482 expression was significantly higher in pterygium tissues compared to normal conjunctival tissues (P<0.001). Positive correlations were observed between hsa_circ_0007482 expression and pterygium severity, thickness, and vascular density. Knockdown of hsa_circ_0007482 inhibited cell proliferation, reducing the mRNA expression of Ki67, PCNA, and Cyclin D1 in HPFs. Hsa_circ_0007482 knockdown induced apoptosis, increasing mRNA expression levels of Bax and Caspase-3, while decreasing Bcl-2 expression in HPFs. Additionally, hsa_circ_0007482 knockdown attenuated vimentin expression in HPFs. CONCLUSION: The downregulation of hsa_circ_0007482 effectively hampers cell proliferation and triggers apoptosis in HPFs. There are discernible positive correlations detected between the expression of hsa_circ_0007482 and the severity of pterygium.
    2  Hydrogel dressings on neurotrophic keratitis in an experimental animal model
    Hua-Qin Xia ,  Xiao-Dan Jiang ,  Yi-Fan Song ,  Xue-Min Li ,  Yan-Jie Tian
    2024, 17(8):1396-1402. DOI: 10.18240/ijo.2024.08.02
    [Abstract](78) [HTML](0) [PDF 1.67 M](190)
    Abstract:
    AIM: To investigate the therapeutic effects of hydrogel dressings on neurotrophic keratitis in rats. METHODS: Male Wistar rats, aged 42–56d, were randomly divided into control, experimental, and treatment groups, each consisting of five rats. The experimental and treatment groups underwent neurotrophic keratitis modeling in both eyes. After successful modeling, biomedical hydrogels formed with polyvinyl alcohol and polyvinyl pyrrolidone were used in treatment group for 7d. Ocular irritation response and keratitis index scores, Schirmer’s test, tear film break-up time (BUT), sodium fluorescein staining, and hematoxylin and eosin (HE) staining were used to evaluate the effectiveness of the treatment. RESULTS: The neurotrophic keratitis model was successfully established in rats with severe ophthalmic nerve injury, characterized by keratitis, ocular irritation, reduced tear secretion measured by decreased BUT and Schirmer test values, corneal epithelial loss, and disorganized collagen fibers in the stromal layer. Following treatment with hydrogel dressings, significant improvements were observed in keratitis scores and ocular irritation symptoms in model eyes. Although the recovery of tear secretion, as measured by the Schirmer’s test, did not show statistical differences, BUT was significantly prolonged. Fluorescein staining confirmed a reduction in the extent of corneal epithelial loss after treatment. HE staining revealed the restoration of the structural disorder in both the epithelial and stromal layers to a certain extent. CONCLUSION: Hydrogel dressing reduces ocular surface irritation, improves tear film stability, and promotes the repair and restoration of damaged epithelial cells by maintaining a moist and clean environment on the ocular surface in the rat model.
    3  Knockdown of fibrillin-1 suppresses retina-blood barrier dysfunction by inhibiting vascular endothelial apoptosis under diabetic conditions
    Yue Zhang ,  Xiao-Jing Liu ,  Xin-Ran Zhai ,  Yao Yao ,  Bin Shao ,  Yu-Han Zhen ,  Xin Zhang ,  Zhe Xiao ,  Li-Fang Wang ,  Ming-Lian Zhang ,  Zhi-Min Chen
    2024, 17(8):1403-1410. DOI: 10.18240/ijo.2024.08.03
    [Abstract](76) [HTML](0) [PDF 2.46 M](308)
    Abstract:
    AIM: To investigate the effects of fibrillin-1 (FBN1) deletion on the integrity of retina-blood barrier function and the apoptosis of vascular endothelial cells under diabetic conditions. METHODS: Streptozotocin (STZ)-induced diabetic mice were used to simulate the diabetic conditions of diabetic retinopathy (DR) patients, and FBN1 expression was detected in retinas from STZ-diabetic mice and controls. In the Gene Expression Omnibus (GEO) database, the GSE60436 dataset was selected to analyze FBN1 expressions in fibrovascular membranes from DR patients. Using lentivirus to knock down FBN1 levels, vascular leakage and endothelial barrier integrity were detected by Evans blue vascular permeability assay, fluorescein fundus angiography (FFA) and immunofluorescence labeled with tight junction marker in vivo. High glucose-induced monkey retinal vascular endothelial cells (RF/6A) were used to investigate effects of FBN1 on the cells in vitro. The vascular endothelial barrier integrity and apoptosis were detected by trans-endothelial electrical resistance (TEER) assay and flow cytometry, respectively. RESULTS: FBN1 mRNA expression was increased in retinas of STZ-induced diabetic mice and fibrovascular membranes of DR patients (GSE60436 datasets) using RNA-seq approach. Besides, knocking down of FBN1 by lentivirus intravitreal injection significantly inhibited the vascular leakage compared to STZ-DR group by Evans blue vascular permeability assay and FFA detection. Expressions of tight junction markers in STZ-DR mouse retinas were lower than those in the control group, and knocking down of FBN1 increased the tight junction levels. In vitro, 30 mmol/L glucose could significantly inhibit viability of RF/6A cells, and FBN1 mRNA expression was increased under 30 mmol/L glucose stimulation. Down-regulation of FBN1 reduced high glucose (HG)-stimulated retinal microvascular endothelial cell permeability, increased TEER, and inhibited RF/6A cell apoptosis in vitro. CONCLUSION: The expression level of FBN1 increases in retinas and vascular endothelial cells under diabetic conditions. Down-regulation of FBN1 protects the retina of early diabetic rats from retina-blood barrier damage, reduce vascular leakage, cell apoptosis, and maintain vascular endothelial cell barrier function.
    4  Key genes and regulatory networks for diabetic retinopathy based on hypoxia-related genes: a bioinformatics analysis
    Cai-Han Yu ,  Cai-Xia Wu ,  Dai Li ,  Lan-Lan Gong ,  Xu-Dong Lyu ,  Jie Yang
    2024, 17(8):1411-1417. DOI: 10.18240/ijo.2024.08.04
    [Abstract](74) [HTML](0) [PDF 3.29 M](321)
    Abstract:
    AIM: To prevent neovascularization in diabetic retinopathy (DR) patients and partially control disease progression. METHODS: Hypoxia-related differentially expressed genes (DEGs) were identified from the GSE60436 and GSE102485 datasets, followed by gene ontology (GO) functional annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Potential candidate drugs were screened using the CMap database. Subsequently, a protein-protein interaction (PPI) network was constructed to identify hypoxia-related hub genes. A nomogram was generated using the rms R package, and the correlation of hub genes was analyzed using the Hmisc R package. The clinical significance of hub genes was validated by comparing their expression levels between disease and normal groups and constructing receiver operating characteristic curve (ROC) curves. Finally, a hypoxia-related miRNA-transcription factor (TF)-Hub gene network was constructed using the NetworkAnalyst online tool. RESULTS: Totally 48 hypoxia-related DEGs and screened 10 potential candidate drugs with interaction relationships to upregulated hypoxia-related genes were identified, such as ruxolitinib, meprylcaine, and deferiprone. In addition, 8 hub genes were also identified: glycogen phosphorylase muscle associated (PYGM), glyceraldehyde-3-phosphate dehydrogenase spermatogenic (GAPDHS), enolase 3 (ENO3), aldolase fructose-bisphosphate C (ALDOC), phosphoglucomutase 2 (PGM2), enolase 2 (ENO2), phosphoglycerate mutase 2 (PGAM2), and 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 (PFKFB3). Based on hub gene predictions, the miRNA-TF-Hub gene network revealed complex interactions between 163 miRNAs, 77 TFs, and hub genes. The results of ROC showed that the except for GAPDHS, the area under curve (AUC) values of the other 7 hub genes were greater than 0.758, indicating their favorable diagnostic performance. CONCLUSION: PYGM, GAPDHS, ENO3, ALDOC, PGM2, ENO2, PGAM2, and PFKFB3 are hub genes in DR, and hypoxia-related hub genes exhibited favorable diagnostic performance.
    5  Intra- and interobserver reliability of ocular surface analyzer LacryDiag®
    Eva Kos ,  Valentina Cigić ,  Mladen Bušić ,  Mirjana Bjeloš ,  Daliborka Miletić ,  Biljana Kuzmanović Elabjer
    2024, 17(8):1418-1422. DOI: 10.18240/ijo.2024.08.05
    [Abstract](43) [HTML](0) [PDF 952.48 K](143)
    Abstract:
    AIM: To invastigate intra- and interobserver reliability of interferometry, tear meniscus height (TMH) measurement and meibography (MBG) of an ocular surface analyzer, LacryDiag (Quantel Medical, France). METHODS: Five consecutive measurements and subsequent analysis of interferometry, TMH, and MBG were recorded by two examiners using the LacryDiag. To assess intra- and interobserver reliability, we used Cohen’s kappa for categorical variables (interferometry), or intraclass correlation coefficient for continuous variables (TMH, MBG). RESULTS: Thirty eyes of 30 examinees were included. For both observers, there was excellent intraobserver reliability for MBG (0.955 and 0.970 for observer 1 and 2, respectively). Intraobserver reliability for observer 1 was substantial for interferometry (0.799), and excellent for TMH (0.863). Reliability for observer 2 was moderate for interferometry (0.535) and fair to good for TMH (0.431). Interobserver reliability was poor for interferometry (0.074) and fair to good for TMH (0.680) and MBG (0.414). CONCLUSION: LacryDiag ocular surface analyzer in our study proves to be a reliable noninvasive tool for the evaluation of TMH and MBG. As for interferometry, poor interobserver reliability, fair to good intraobserver reliability for observer 1, and moderate for observer 2, leave room for improvement.
    6  Prognostic factors for lacrimal gland adenoid cystic carcinoma: a retrospective study in Chinese patients
    Lu-Di Yang ,  Shi-Chong Jia ,  Jie Yang ,  Xin Song ,  Ye-Fei Wang ,  Xian-Qun Fan
    2024, 17(8):1423-1430. DOI: 10.18240/ijo.2024.08.06
    [Abstract](58) [HTML](0) [PDF 1.51 M](215)
    Abstract:
    AIM: To explore the prognostic factors for lacrimal gland adenoid cystic carcinoma (LGACC) in Chinese patients. METHODS: Clinical and histopathological data were reviewed in patients with pathologically confirmed LGACC. Local recurrence, metastasis, and disease-specific death were the main outcome measures. Univariate and multivariate analyses were performed by the Kaplan-Meier method and a Cox proportional hazard model. RESULTS: This retrospective cohort study included 45 patients with pathologically confirmed LGACC between January 2008 and June 2022. Tumor (T) classification (P=0.005), nodal metastasis (N) classification (P=0.018) and positive margin (P=0.008) were independent risk factors of recurrence; T (P=0.013) and N (P=0.003) classification and the basaloid tumor type (P=0.032) were independent risk factors for metastasis; T classification (P<0.001) was an independent factor of death of disease. In the further analysis, the durations from first surgery to radiotherapy is correlated with metastatic risk in LGACC patients with basaloid component (P=0.022). CONCLUSION: Histological subtype should be emphasized when evaluating prognosis and guiding treatment. Timely radiotherapy may reduce the risk of metastasis in patients with basaloid component.
    7  A surgical alternative of fusiform penetrating keratoplasty for the management of severe infectious keratitis
    Xiao-Lin Qi ,  Li-Chao Wang ,  Miao-Lin Wang ,  Hua Gao
    2024, 17(8):1431-1436. DOI: 10.18240/ijo.2024.08.07
    [Abstract](54) [HTML](0) [PDF 1.54 M](169)
    Abstract:
    AIM: To describe the surgical procedure of fusiform penetrating keratoplasty (FPK) using multiple trephines of different sizes for treating patients with severe infectious keratitis. METHODS: Fourteen eyes underwent FPK, and 15 eyes received conventional penetrating keratoplasty (PK) were included in the study. The best-corrected visual acuity (BCVA), refractive outcomes, endothelial cell density, and postoperative complications were recorded. RESULTS: The FPK group was followed for an average of 15.3±2.1mo, whereas the PK group was followed for 16.1±1.9mo. The corneal ulcers were elliptical-shaped in all 14 eyes in the FPK group. The mean BCVA (logMAR, 0.26±0.13) showed no statistically significant differences from that in the PK group (logMAR, 0.21±0.12, P>0.05) at 1y after surgery. But the mean curvature, mean astigmatism, and mean spherical equivalent in the FPK group were lower than those in the PK group (P<0.05). Peripheral anterior synechia was observed in one patient in the FPK group, whereas 6 patients in the PK group. Suture loosening and neovascularization were observed in 4 and 5 eyes in the PK group, respectively. No graft immune rejection or elevation of intraocular pressure was observed in the two groups. CONCLUSION: For patients with elliptical-shaped corneas or corneal ulcers, FPK can avoid disrupting of corneal limbus, reduce the risk of postoperative complications, and can result in satisfactory visual quality.
    8  Comparison of ocular biometric parameters between two swept-source optical coherence tomography devices and Scheimpflug tomography in patients with cataract
    Shan Ma ,  Cheng Li ,  Jing Sun ,  Jun Yang ,  Kai Wen ,  Xi-Teng Chen ,  Fang-Yu Zhao ,  Rong-Yu Gao ,  Fang Tian
    2024, 17(8):1437-1446. DOI: 10.18240/ijo.2024.08.08
    [Abstract](66) [HTML](0) [PDF 2.45 M](197)
    Abstract:
    AIM: To assess and compare the variations and agreements across different ocular biometric parameters using swept-source optical coherence tomography (SS-OCT) and Scheimpflug tomography in patients diagnosed with cataract. METHODS: This prospective case series was conducted at Tianjin Medical University Eye Hospital. In total, 212 eyes from 212 patients scheduled for phacoemulsification were included. Eyes were evaluated preoperatively using two SS-OCT devices (IOLMaster700 and CASIA2) and Scheimpflug tomography (Pentacam). Central corneal thickness (CCT), anterior chamber depth (ACD), aqueous depth (AQD), white-to-white distance (WTW), flat simulated keratometry (Kf), steep simulated keratometry (Ks), mean keratometry (Km), and total corneal keratometry (TKm) were measured. Intraclass correlation coefficient (ICC), 95% confidence intervals (CI) and limits of agreement (LoA) widths were conducted to assess differences and correlations between devices. RESULTS: All parameters, except for Ks, were significantly different. Pairwise comparison revealed no significant differences between keratometry obtained by IOLMaster 700 and Pentacam. LoA widths of all paired comparisons for Ks were >0.80 D. Except for WTW between IOLMaster 700 and CASIA2 and between CASIA2 and Pentacam, other Pearson’s coefficients between devices showed a strong correlation (all r>0.95). The ICC of WTW (ICC=0.438, 95%CI 0.167-0.625) showed poor reliability. The reliability of CCT, ACD, and AQD was excellent (all ICC>0.95), whereas that of TKm was good (ICC=0.827, 95%CI 0.221-0.939). A significant linear correlation was also observed among devices. CONCLUSION: The ocular parameters derived from the use of IOLMaster700, CASIA2, and Pentacam exhibit significant discrepancies; as such, measurements from these devices should not be deemed as interchangeable.
    9  EVA NEXUS-Phaco performance study
    Lukas Feldhaus ,  Andreas Ohlmann ,  Stefan Kassumeh ,  Siegfried Priglinger ,  Wolfgang Mayer
    2024, 17(8):1447-1452. DOI: 10.18240/ijo.2024.08.09
    [Abstract](55) [HTML](0) [PDF 763.25 K](158)
    Abstract:
    AIM: To investigate a novel phacoemulsification system “EVA NEXUS” (D.O.R.C., Dutch Opthalmic Research Center) in comparison to the existing system “EVA” in clinical use. And to compare both phacoemulsification systems in terms of efficiency, safety and postoperative inflammatory activity. METHODS: In this study standardized cataract surgery was performed on both eyes of the study participant, using the “EVA system” (control group, n=20) on one eye and the “EVA NEXUS system” (intervention group, n=20) on the other eye. Only patients with cataract LOCS Grading 1-3 and no accompanying eye diseases were included in this study. A total of 20 patients were included in this study, with each treatment arm including 20 eyes. During surgery a 0.1 mL aqueous humor sample was collected 1min after phacoemulsification to measure the total prostaglanin E2 concentrations using an enzyme-linked immunosorbent assay. The endothelial cell count, visual and refractive outcomes, and anterior chamber flare were evaluated preoperatively, and 1d, 1wk, and 3mo postoperatively. RESULTS: There were no statistically significant differences between both groups regarding intraoperative safety parameters including effective phacoemulsification time (P=0.904), balanced saline solution flow (P=0.701) and total surgery time (P=0.565). Postoperative prostaglandin E2 levels, anterior chamber flare as well as endothelial cell loss tended to be lower in the NEXUS-Group, however not being statistically significant (P=0.718; 0.164; 0.486). Both systems provided similar clinical outcomes, regarding best corrected visual acuity and refractive parameters, showing no statistically significant differences between both groups. CONCLUSION: Both systems show a high level of safety and efficency with similar results in terms of safety parameters including postoperative inflammatory activity and endothelial cell loss as well as visual and refractive outcomes. Although statistically not significant, the EVA NEXUS system tends to cause less postoperative inflammation with lower prostaglandin E2 levels and lower anterior chamber flare values.
    10  Changes of the peripapillary vascular parameters in premature infants without retinopathy of prematurity using U-net segmentation
    Shuai Liu ,  Lei Liu ,  Cui-Xia Ma ,  Liu-Hui Huang ,  Bin Li
    2024, 17(8):1453-1461. DOI: 10.18240/ijo.2024.08.10
    [Abstract](39) [HTML](0) [PDF 1.95 M](158)
    Abstract:
    AIM: To quantitatively assess the changes in mean vascular tortuosity (mVT) and mean vascular width (mVW) around the optic disc and their correlation with gestational age (GA) and birth weight (BW) in premature infants without retinopathy of prematurity (ROP). METHODS: A single-center retrospective study included a total of 133 (133 eyes) premature infants [mean corrected gestational age (CGA) 43.6wk] without ROP as the premature group and 130 (130 eyes) CGA-matched full-term infants as the control group. The peripapillary mVT and mVW were quantitatively measured using computer-assisted techniques. RESULTS: Premature infants had significantly higher mVT (P=0.0032) and lower mVW (P=0.0086) by 2.68 (104 cm-3) and 1.85 μm, respectively. Subgroup analysis with GA showed significant differences (P=0.0244) in mVT between the early preterm and middle to late preterm groups, but the differences between mVW were not significant (P=0.6652). The results of the multiple linear regression model showed a significant negative correlation between GA and BW with mVT after adjusting sex and CGA (P=0.0211 and P=0.0006, respectively). For each day increase in GA at birth, mVT decreased by 0.1281 (104 cm-3) and for each 1 g increase in BW, mVT decreased by 0.006 (104 cm-3). However, GA (P=0.9402) and BW (P=0.7275) were not significantly correlated with mVW. CONCLUSION: Preterm birth significantly affects the peripapillary vascular parameters that indicate higher mVT and narrower mVW in premature infants without ROP. Alterations in these parameters may provide new insights into the pathogenesis of ocular vascular disease.
    11  Differential distribution of fibrovascular proliferative membranes in 25-gauge vitrectomy for proliferative diabetic retinopathy
    Nan Lu ,  Shi-Lin Yang ,  Shuo Guo ,  Dong-Ni Yang ,  Li Liu ,  Chun-Hui Fan ,  Ying Guo ,  Jian Liu ,  Wei Zhao
    2024, 17(8):1462-1468. DOI: 10.18240/ijo.2024.08.11
    [Abstract](38) [HTML](0) [PDF 919.08 K](192)
    Abstract:
    AIM: To analyze the distribution of fibrovascular proliferative membranes (FVPMs) in proliferative diabetic retinopathy (PDR) patients that treated with pars plana vitrectomy (PPV), and to evaluate the outcomes separately. METHODS: This was a retrospective and cross-sectional study. Consecutive 25-gauge (25-G) PPV cases operated for PDR from May 2018 to April 2020. According to the FVPMs images outlined after operations, subjects were assigned into three groups: arcade type group, juxtapapillary type group, and central type group. All patients were followed up for over one year. General characteristics, operation-related variables, postoperative parameters and complications were recorded. RESULTS: Among 103 eyes recruited, the FVPMs distribution of nasotemporal and inferiosuperioral was significantly different (both P<0.01), with 95 (92.23%) FVPMs located in the nasal quadrants, and 74 (71.84%) in the inferior. The eyes with a central FVPM required the longest operation time, with silicon oil used in most patients, generally combined with tractional retinal detachment (RD) and rhegmatogenous RD, the worst postoperative best-corrected visual acuity (BCVA) and the highest rates of recurrent RD (all P<0.05). FVPM type, age of onset diabetes mellitus, preoperative BCVA, and combined with tractional RD and rhegmatogenous RD were significantly associated with BCVA improvement (all P<0.05). Compared with the central type group, the arcade type group had higher rates of BCVA improvement. CONCLUSION: FVPMs are more commonly found in the nasal and inferior mid-peripheral retina in addition to the area of arcade vessels. Performing 25-G PPV for treating PDR eyes with central FVPM have relatively worse prognosis.
    12  Multimodal imaging diagnosis and analysis of prognostic factors in patients with adult-onset Coats disease
    Wei Zhou ,  Hui Zhou ,  Yuan-Yuan Liu ,  Meng-Xuan Li ,  Xiao-Han Wu ,  Jiao Liang ,  Jing Hao ,  Sheng-Nan Liu ,  Chun-Jie Jin
    2024, 17(8):1469-1476. DOI: 10.18240/ijo.2024.08.12
    [Abstract](46) [HTML](0) [PDF 2.06 M](247)
    Abstract:
    AIM: To describe the multimodal imaging features, treatment, and outcomes of patients diagnosed with adult-onset Coats disease. METHODS: This retrospective study included patients first diagnosed with Coats disease at ≥18 years of age between September 2017 and September 2021. Some patients received anti-vascular endothelial growth factor (VEGF) therapy (conbercept, 0.5 mg) as the initial treatment, which was combined with laser photocoagulation as needed. All the patients underwent best corrected visual acuity (BCVA) and intraocular pressure examinations, fundus color photography, spontaneous fluorescence tests, fundus fluorescein angiography, optical coherence tomography (OCT), OCT angiography, and other examinations. BCVA alterations and multimodal image findings in the affected eyes following treatment were compared and the prognostic factors were analyzed. RESULTS: The study included 15 patients who were aged 24-72 (57.33±12.61)y at presentation. Systemic hypertension was the most common associated systemic condition, occurring in 13 (86.7%) patients. Baseline BCVA ranged from 2.0 to 5.0 (4.0±1.1), which showed improvement following treatment (4.2±1.0). Multimodal imaging revealed retinal telangiectasis in 13 patients (86.7%), patchy hemorrhage in 5 patients (33.3%), and stage 2B disease (Shield’s staging criteria) in 11 patients (73.3%). OCT revealed that the baseline central macular thickness (CMT) ranged from 129 to 964 µm (473.0±230.1 µm), with 13 patients (86.7%) exhibiting a baseline CMT exceeding 250 µm. Furthermore, 8 patients (53.3%) presented with an epiretinal membrane at baseline or during follow-up. Hyper-reflective scars were observed on OCT in five patients (33.3%) with poor visual prognosis. Vision deteriorated in one patient who did not receive treatment. Final vision was stable in three patients who received laser treatment, whereas improvement was observed in one of two patients who received anti-VEGF therapy alone. In addition, 8 of 9 patients (88.9%) who received laser treatment and conbercept exhibited stable or improved BCVA. CONCLUSION: Multimodal imaging can help diagnose adult-onset Coats disease. Anti-VEGF treatment combined with laser therapy can be an option for improving or maintaining BCVA and resolving macular edema. The final visual outcome depends on macular involvement and the disease stage.
    13  Relative peripheral refraction in school children with different refractive errors using a novel multispectral refraction topographer
    Hui-Ling Hu ,  Serena Zhe-Chuang Li ,  Ai-Ying Feng ,  Hao-Xi Zhong ,  Jing-Feng Mu ,  Mei-Zhou Liu
    2024, 17(8):1477-1482. DOI: 10.18240/ijo.2024.08.13
    [Abstract](40) [HTML](0) [PDF 1.78 M](174)
    Abstract:
    AIM: To compare relative peripheral refraction (RPR) in Chinese school children with different refractive errors using multispectral refraction topography (MRT). METHODS: A total of 713 eyes of primary school children [172 emmetropia (E), 429 low myopia (LM), 80 moderate myopia (MM), and 32 low hypermetropia (LH)] aged 10 to 13y were analyzed. RPRs were measured using MRT without mydriasis. MRT results showed RPR at 0-15° (RPR 0-15), 15°-30° (RPR 15-30), and 30°-45° (RPR 30-45) annular in the inferior (RPR-I), superior (RPR-S), nasal (RPR-N), and temporal (RPR-T) quadrants. Spherical equivalent (SE) was detected and calculated using an autorefractor. RESULTS: There were significant differences of RPR 15-30 between groups MM [0.02 (-0.12; 0.18)] and LH [-0.13 (-0.36; 0.12)] (P<0.05), MM and E [-0.06 (-0.20; 0.10)] (P<0.05), and LM [-0.02 (-0.15; 0.15)] and E (P<0.05). There were also significant differences of RPR 30-45 between groups MM [0.45 (0.18; 0.74)] and E [0.29 (-0.09; 0.67)] (P<0.05), and LM [0.44 (0.14; 0.76)] and E (P<0.001). RPR values increased from the hyperopic to medium myopic group in each annular. There were significant differences of RPR-S between groups MM [-0.02 (-0.60; 0.30)] and E [-0.44 (-0.89; -0.04)] (P<0.001), and LM [-0.28 (-0.71; 0.12)] and E (P<0.05). There were also significant differences of RPR-T between groups MM [0.37 (0.21; 0.78)] and LH [0.14 (-0.52; 0.50)] (P<0.05), LM [0.41 (0.06; 0.84)] and LH (P<0.05), and LM and E [0.29 (-0.10; 0.68), P<0.05]. A Spearman’s correlation analysis showed a negative correlation between RPR and SE in the 15°-30° (P=0.005), 30°-45° (P<0.05) annular (P=0.002), superior (P<0.001), and temporal (P=0.001) quadrants. CONCLUSION: Without pupil dilation, values for RPR 15-30, 30-45, RPR-S, and T shows significant differences between myopic eyes and emmetropia, and the differences are negatively correlated with SE.
    14  Superior rectus/levator complex in acquired anophthalmic socket repaired with spheric implant—a computed tomography scan and topographic study
    Shaikha Al Eid ,  Hamad M AlSulaiman ,  Sahar M Elkhamary ,  Osama Al Sheikh ,  Alicia Ferrero-Galindo ,  Rajiv Kandekhar ,  Silvana A Schellini
    2024, 17(8):1483-1488. DOI: 10.18240/ijo.2024.08.14
    [Abstract](29) [HTML](0) [PDF 766.06 K](125)
    Abstract:
    AIM: To determine whether the levator palpebrae superioris (LPS)/superior rectus (SR) muscle complex, can influence the position of the upper lid and fornix in acquired anophthalmic sockets. METHODS: This comparative non-randomized and non-interventional study included retrospective data of 21 patients with unilateral acquired anophthalmic sockets repaired with spheric implants. High-resolution computed tomography (CT) measurements of the LPM/SR muscle complex and clinical topographic position of the upper lid, superior and inferior fornix depth in primary gaze position were evaluated. Demographic data were presented as frequency and percentage proportions and quantitative variables comparing the socket measurements with the normal contralateral orbit was statistically analyzed using non-parametric tests considering P<0.05. RESULTS: The anophthalmic orbits had a significantly shorter LPS length (P=0.01) and significantly thicker SR (P=0.02) than the normal orbit. Lagophthalmos was present in anophthalmic sockets but not in normal orbits (P=0.002), while levator function was normal in both (P>0.05, all comparisons). The superior fornix depth was similar in the anophthalmic socket and the contralateral normal orbit (P=0.192) as well the inferior fornix depth (P=0.351). CONCLUSION: Acquired anophthalmic sockets repaired with spheric implants have shorter LPS, thicker SR, and more lagophthalmos than normal orbits. The relationship of the LPS and SR with other orbital structures, associated with passive or active forces acting in the final position of the lids and external ocular prosthesis should be further investigated.
    15  Exogenous testosterone therapy on choroid in androgen deficiency
    Volkan Yeter ,  Nurullah Koçak ,  Merve Kalyoncu ,  Ramazan Aşçi ,  Nurşen Aritürk
    2024, 17(8):1489-1494. DOI: 10.18240/ijo.2024.08.15
    [Abstract](39) [HTML](0) [PDF 975.66 K](140)
    Abstract:
    AIM: To investigate the effects of exogenous testosterone treatment on the choroidal parameters in patients with androgen deficiency. METHODS: Right eyes of 24 patients with androgen deficiency and 31 healthy volunteers were included in the study. The eyes were scanned for subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), choroid-stromal area (C-SA), choroid-luminal area (C-LA), choroid-stromal to luminal area ratio (CSLR), and the choroidal parameters within central 1500 µm of the macula (CVI1500, C-LA1500, C-SA1500, and CSLR1500) by enhanced-depth imaging optical coherence tomography (EDI-OCT) at baseline, 6th and 18th weeks of the exogenous testosterone treatment. RESULTS: The mean SFCT values of the androgen deficient groups and healthy controls were 307.7±27.0 and 303.2±37.2 µm (P=0.8). However, CVI, C-SA, CSLR, CVI1500, C-LA1500, and CSLR1500 were significantly different between the groups (all P<0.01). At the 6th week visit after exogenous testosterone treatment, SFCT, CVI, C-LA, and C-SA were significantly decreased, and these parameters returned to baseline levels at the 18th-week visit (all P>0.05). However, CVI1500 and LA1500 significantly increased at the end of the follow-up period (P<0.001). CONCLUSION: CVI is lower in androgen-deficient patients than in healthy subjects. The alterations in the choroid during the testosterone peak are transient in the treatment of patients with androgen deficiency. However, the increase in CVI within the central 1500 µm of the macula persists even after 4mo.
    16  Intraocular pressure and gonioscopic findings in primary angle-closure disease in India—a big data study
    Srikantaiah Ramyashri ,  Anthony Vipin Das ,  Sirisha Senthil
    2024, 17(8):1495-1500. DOI: 10.18240/ijo.2024.08.16
    [Abstract](34) [HTML](0) [PDF 516.22 K](156)
    Abstract:
    AIM: To describe the gonioscopic profile and intraocular pressure (IOP) in primary angle-closure (PAC) disease in patients presenting to a tertiary eye care network in India. METHODS: A cross-sectional hospital-based study that included 31 484 new patients presenting between 2011 and 2021. Patients with a clinical diagnosis of PAC/suspect/glaucoma were included. The data was collected from an electronic medical record system. RESULTS: PAC glaucoma (PACG) (47.55%) was the most common diagnosis followed by PAC (39.49%) and PAC suspect (PACS; 12.96%). Female preponderance (54.6%) was noted with higher mean age at presentation among males (P<0.0001). PACS and PAC showed the highest prevalence in 6th decade but PACG was higher at 7th decade. The probability of angle opening was 95.93%, 90.32% and 63.36% in PACS, PAC and PACG eyes respectively post peripheral iridotomy (PI). Plateau iris syndrome (PIS) was noted in 252 eyes and all showed post dilated rise of IOP. A post dilated IOP rise was also noted with 8.86%, 33.95% and 57.19% eyes with PACS, PAC and PACG respectively with IOP rise between 6-8 mm Hg across the disease spectrum. CONCLUSION: The superior quadrant is the narrowest angle and difficult to open with indentation and post PI. The probability of angle opening is less in PIS especially the complete variety along with post dilated IOP rise. The post dilated IOP rise in angle closure eyes warrants a careful dilatation, especially with PIS.
    17  Publication trends of Leber congenital amaurosis researches: a bibliometric study during 2002-2022
    Xiao-Xu Huang ,  Yi-Min Wang ,  Min-Yue Xie ,  Yi-Qing Sun ,  Xiao-Huan Zhao ,  Yu-Hong Chen ,  Jie-Qiong Chen ,  Si-Yang Han ,  Min-Wen Zhou ,  Xiao-Dong Sun
    2024, 17(8):1501-1509. DOI: 10.18240/ijo.2024.08.17
    [Abstract](45) [HTML](0) [PDF 2.23 M](217)
    Abstract:
    AIM: To analyze the changes in scientific output relating to Leber congenital amaurosis (LCA) and forecast the study trends in this field. METHODS: All of the publications in the field of LCA from 2002 to 2022 were collected from Web of Science (WOS) database. We analyzed the quantity (number of publications), quality (citation and H-index) and development trends (relative research interest, RRI) of published LCA research over the last two decades. Moreover, VOSviewer software was applied to define the co-occurrence network of keywords in this field. RESULTS: A total of 2158 publications were ultimately examined. We found that the focus on LCA kept rising and peaked in 2015 and 2018, which is consistent with the development trend of gene therapy. The USA has contributed most to this field with 1162 publications, 56 674 citations and the highest H-index value (116). The keywords analysis was divided into five clusters to show the hotspots in the field of LCA, namely mechanism-related, genotype-related, local phenotype-related, system phenotype-related, and therapy-related. We also identified gene therapy and anti-retinal degeneration therapy as a major focus in recent years. CONCLUSION: Our study illustrates historical research process and future development trends in LCA field. This may help to guide the orientation for further clinical diagnosis, treatment and scientific research.
    18  Pain perception enhancement in consecutive second-eye phacoemulsification cataract surgeries under topical anesthesia
    Jia-Wei Luo ,  Yan-Hua Chen ,  Jian-Feng Yu ,  Yi-Xun Chen ,  Min Ji ,  Huai-Jin Guan
    2024, 17(8):1510-1518. DOI: 10.18240/ijo.2024.08.18
    [Abstract](56) [HTML](0) [PDF 605.83 K](191)
    Abstract:
    Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery. Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery. However, patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery. The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts. Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system. Immunological, neuropsychological, and pharmacological factors work together in the enhancement of intraoperative pain. Accumulating published literatures have focused on the pain enhancement during the second-eye phacoemulsification surgeries. In this review, we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb. 1, 2024. We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive second-eye phacoemulsification cataract surgeries. This review aimed to provide novel insights into strategies for improving patients’ intraoperative experience in second-eye cataract surgeries.
    19  Artificial intelligence in individualized retinal disease management
    Zi-Ran Zhang ,  Jia-Jun Li ,  Ke-Ran Li
    2024, 17(8):1519-1530. DOI: 10.18240/ijo.2024.08.19
    [Abstract](42) [HTML](0) [PDF 787.55 K](202)
    Abstract:
    Owing to the rapid development of modern computer technologies, artificial intelligence (AI) has emerged as an essential instrument for intelligent analysis across a range of fields. AI has been proven to be highly effective in ophthalmology, where it is frequently used for identifying, diagnosing, and typing retinal diseases. An increasing number of researchers have begun to comprehensively map patients’ retinal diseases using AI, which has made individualized clinical prediction and treatment possible. These include prognostic improvement, risk prediction, progression assessment, and interventional therapies for retinal diseases. Researchers have used a range of input data methods to increase the accuracy and dependability of the results, including the use of tabular, textual, or image-based input data. They also combined the analyses of multiple types of input data. To give ophthalmologists access to precise, individualized, and high-quality treatment strategies that will further optimize treatment outcomes, this review summarizes the latest findings in AI research related to the prediction and guidance of clinical diagnosis and treatment of retinal diseases.
    20  NLRP3 and autophagy in retinal ganglion cell inflammation in age-related macular degeneration: potential therapeutic implications
    Xiao-Li Wang ,  Yun-Xia Gao ,  Qiong-Zhen Yuan ,  Ming Zhang
    2024, 17(8):1531-1544. DOI: 10.18240/ijo.2024.08.20
    [Abstract](61) [HTML](0) [PDF 1.62 M](310)
    Abstract:
    Retinal degenerative diseases were a large group of diseases characterized by the primary death of retinal ganglion cells (RGCs). Recent studies had shown an interaction between autophagy and nucleotide-binding oligomerization domain-like receptor 3 (NLRP3) inflammasomes, which may affect RGCs in retinal degenerative diseases. The NLRP3 inflammasome was a protein complex that, upon activation, produces caspase-1, mediating the apoptosis of retinal cells and promoting the occurrence and development of retinal degenerative diseases. Upregulated autophagy could inhibit NLRP3 inflammasome activation, while inhibited autophagy can promote NLRP3 inflammasome activation, which leaded to the accelerated emergence of drusen and lipofuscin deposition under the neurosensory retina. The activated NLRP3 inflammasome could further inhibit autophagy, thus forming a vicious cycle that accelerated the damage and death of RGCs. This review discussed the relationship between NLRP3 inflammasome and autophagy and its effects on RGCs in age-related macular degeneration, providing a new perspective and direction for the treatment of retinal diseases.
    21  Retinal displacement after surgery for idiopathic macular hole
    He-Cong Qin ,  Fu-Qiang Li ,  Si-Yan Jin ,  Jin-Song Zhao
    2024, 17(8):1545-1556. DOI: 10.18240/ijo.2024.08.21
    [Abstract](40) [HTML](0) [PDF 1.09 M](185)
    Abstract:
    AIM: To review and summarize the mechanism hypothesis, influencing factors and possible consequences of macular retinal displacement after idiopathic macular hole (IMH) surgery. METHODS: PubMed and Web of Science database was searched for studies published before April 2023 on “Retinal displacement”, “Idiopathic macular holes”, and “Macular displacement”. RESULTS: Recently, more academics have begun to focus on retinal displacement following idiopathic macular holes. They found that internal limiting membrane (ILM) peeling was the main cause of inducing postoperative position shift in the macular region. Moreover, several studies have revealed that the macular hole itself, as well as ILM peeling method, will have an impact on the result. In addition, this phenomenon is related to postoperative changes in macular retinal thickness, cone outer segment tips line recovery, the occurrence of dissociated optic nerve fiber layer (DONFL) and the degree of metamorphopsia. CONCLUSION: As a subclinical phenomenon, the clinical significance of postoperative macular displacement cannot be underestimated as it may affect the recovery of anatomy and function.
    22  Rapid progress of an iris metastasis from esophageal cancer: a case report and review of literature
    Meng Xie ,  Xing-Hua Wang ,  Jun-Jie Yang ,  Zi-Xuan Su ,  Jia-Hui Huang ,  Peng-Cheng Li ,  Fa-Gang Jiang
    2024, 17(8):1557-1567. DOI: 10.18240/ijo.2024.08.22
    [Abstract](44) [HTML](0) [PDF 1.69 M](244)
    Abstract:
    This case report details a rare instance of rapid iris metastasis from esophageal cancer in a 59-year-old man. A literature review was conducted to explore recent advances in detecting, diagnosing, and treating intraocular metastatic malignancies. Positron emission tomography-computed tomography played a crucial role in identifying primary sites and systemic metastases. Local treatment combined with systemic therapy effectively reduced tumor size, preserved useful vision, and improved the patient’s survival rate. A comparison was made of the characteristics of iris metastases from esophageal cancer and lung cancer, including age, gender, tumor characteristics, and treatment. The challenges associated with diagnosis and treatment are discussed, highlighting the implications for clinical practice.
    23  Resolution of myopic macular schisis following cataract phacoemulsification
    Yan-Ting Li ,  Bo Jiang ,  Xin-Zhu Chen ,  Hang Ren ,  Yan-Hui Xiao ,  Zi-Yue Song ,  Pei-Rong Lu
    2024, 17(8):1568-1570. DOI: 10.18240/ijo.2024.08.23
    [Abstract](80) [HTML](0) [PDF 735.15 K](142)
    Abstract:
    24  Alzheimer’s visual variant: a report of a diagnosis easily missed on ophthalmic examination
    Jorge Cárdenas-Belaunzarán ,  Lorena Wheelock-Gutierrez ,  Karen A. Cerrillo-Avila
    2024, 17(8):1571-1575. DOI: 10.18240/ijo.2024.08.24
    [Abstract](97) [HTML](0) [PDF 1.01 M](140)
    Abstract:
    25  Comment on: Effect of intubation in patients with functional epiphora after endoscopic dacryocystorhinostomy
    Mansooreh Jamshidian-Tehrani ,  Hossein Ghahvehchian ,  Christopher J Compton ,  Jeremy D Clark ,  Nicole L West ,  Mohsen Bahmani Kashkouli
    2024, 17(8):1576-1576. DOI: 10.18240/ijo.2024.08.25
    [Abstract](72) [HTML](0) [PDF 215.44 K](111)
    Abstract:
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