Abstract:AIM: To explore the effect of co-host non-coding RNA (ncRNA) MIR503HG/miR-503-5p on the angiogenesis of pterygium. METHODS: MIR503HG/miR-503-5p/fibroblast growth factor 2 (FGF2) expression levels in pterygium tissues, control conjunctival tissues, and human pterygium fibroblasts (HPF) were examined by reverse transcription-polymerase chain reaction (qRT-PCR) and immunohistochemical methods. Effects of MIR503HG/miR-503-5p on low molecular weight FGF2 (LWM FGF2), migration and angiogenesis of human retinal microvascular endothelial cells (HRMEC) were determined in an HPF and HRMEC co-culture model using Western blots, wound healing assay, Matrigel-based tube formation assay, and Transwell assay. RESULTS: MIR503HG/miR-503-5p/FGF2 pathway was actively increased in pterygium tissue and there was a negative correlation between the expression of the two ncRNAs. FGF2 expression level was positively correlated with MIR503HG and negatively correlated with miR-503-5p. Overexpressed MIR503HG/miR-503-5p did not affect the migration and angiogenesis of HRMECs cultured separately, but significantly affected migration and angiogenesis of HRMEC in HPF and HRMEC co-culture models. Western blotting revealed that MIR503HG/miR-503-5p overexpression significantly increased LMW FGF2 expression in HPF. CONCLUSION: MIR503HG/miR-503-5p inhibits HRMEC migration and angiogenic function by interfering with the interaction between HPF and endothelial cells via reducing LMW FGF2 in HPF.

Abstract:AIM: To investigate the effect of skullcapflavone II (SCF-II) on the epithelial-mesenchymal transition (EMT) induced by transforming growth factor beta (TGF-β) in human corneal epithelial cells (HCECs), as well as to identify the signaling pathways that may be involved. METHODS: HCECs were cultured in vitro. At a SCF-II (5, 10 µmol/L) dose, cell viability was analysed with a cell counting kit-8 (CCK-8) assay, and cell migration was monitored with wound healing and Transwell migration assays. There were 4 groups: SCF-II, TGF-β, SCF-II+TGF-β and Control. Western blotting and immunofluorescence were performed to show the expression of EMT markers and the translocation of nuclear factor kappa-B (NF-κB) into the nucleus in the 4 groups. RESULTS: Treatment with SCF-II decreased HCEC viability in a dose-dependent manner. A concentration below 10 µmol/L did not present obvious cell toxicity, and survival rates were more than 70% at 48h. Treatment with SCF-II (5 and 10 µmol/L) significantly impeded migration in wound healing and Transwell migration assays (P<0.05), and EMT markers and NF-κB translocation into the nucleus were inhibited. After both TGF-β and SCF-II treatment, the migration of TGF-β-treated HCECs were suppressed by SCF-II (P<0.05). The expression levels of the mesenchymal markers N-cadherin (P<0.05), α-smooth muscle actin (α-SMA; P<0.05) and NF-κB (P<0.05) in both TGF-β- and SCF-II-treated HCECs were lower than those in the HCECs treated with TGF-β alone and higher than those in HCECs treated with SCF-II alone. Immunofluorescence showed that the entry of NF-κB into the nucleus in both TGF-β- and SCF-II-treated HCECs was less than that in the TGF-β-treated HCECs. CONCLUSION: SCF-II inhibit TGF-β-induced EMT in HCECs by potentially regulating the NF-κB signalling pathway. Thus, SCF-II represents a candidate putative therapeutic agent in corneal fibrotic diseases.

Abstract:AIM: To explore the effect and mechanism of Lycium barbarum polysaccharide (LBP) inhibiting retinal neovascularization. METHODS: In vitro tests were performed on human retinal microvascular endothelial cells (HRECs) from three groups, including control group (normal oxygen), hypoxic group (hypoxia at 37℃, 1% O2, 5% CO2, and 94% N2), and LBP group (hypoxic group with LBP 100 μg/mL). In vivo experiments, C57 mice were divided into three groups: control group (normal rearing group), the oxygen-induced ischemic retinopathy (OIR) group, and the OIR with 50 mg/kg LBP group. Retinal neovascularization was observed by fluorescein angiography and quantified. Retinal thickness was evaluated by Hematoxylin and eosin (HE) stain. The expression of epidermal growth factor receptor (EGFR), phosphatidylinositol 3-kinase (PI3K), mammalian target of rapamycin (mTOR), phosphorylated mammalian target of rapamycin (p-mTOR), protein kinase B (AKT), phosphorylated protein kinase B (p-AKT), interleukin-1β (IL-1β), inducible nitric oxide synthase (iNOS), and tumor necrosis factor-α (TNF-α) in each group were analyzed by Western blot. IL-1β level in retina was analyzed using immunohistochemical staining. RESULTS: The increased area of neovascular clusters in OIR mice was significantly decreased by LBP. Retinal thickness of OIR mice was significantly thinner compared with normal oxygenated mice and was increased in LBP group. Compared with those in the hypoxic groups, Western blotting of HRECs and retinal tissues revealed that the expression of EGFR, PI3K, p-mTOR, p-AKT, IL-1β, iNOS, and TNF-α decreased in the LBP group but was still greater than that in control group. Moreover, IL-1β was reduced in retinal sections treated with LBP. In the scratch test, the cell migration of the hypoxic group was significantly greater than that of the control group, while LBP treatment attenuated this increase in migration. CONCLUSION: LBP reduces retinal neovascularization and inflammation in vivo and inhibits the migration of HRECs in vitro by regulating the EGFR/PI3K/Akt/mTOR signaling pathway.

Abstract:AIM: To investigate the effects of adenosine triphosphate (ATP) and melatonin, which have antioxidant and anti-inflammatory activities, on potential 5-fluorouracil (5-FU)-induced optic nerve damage in rats. METHODS: Twenty-four rats were categorized into four groups of six rats: healthy (HG), 5-FU (FUG), ATP+5-FU (AFU), and melatonin+5-FU (MFU). ATP (4 mg/kg) and melatonin (10 mg/kg) were administered intraperitoneally and orally, respectively. One hour after ATP and melatonin administration, rats in the AFU, MFU, and FUG were intraperitoneally injected with 5-FU (100 mg/kg). ATP and melatonin were administered once daily for 10d. 5-FU was administered at a single dose on days 1, 3, and 5 of the experiment. After 10d, the rats were euthanized and optic nerve tissues were extracted. Optic nerve tissues were biochemically and histopathologically examined. RESULTS: ATP and melatonin treatments inhibited the increase in malondialdehyde (MDA) and interleukin-6 (IL-6) levels, which were elevated in the FUG. The treatments also prevented the decrease in total glutathione (tGSH) levels and the superoxide dismutase (SOD) and catalase (CAT) activities (P<0.001). This inhibition was higher in the ATP group than in the melatonin group (P<0.001). ATP prevented histopathological damage better than melatonin (P<0.05). CONCLUSION: ATP and melatonin have the potential to be used in alleviating 5-FU-induced optic nerve damage. In addition, ATP treatment shows better protective effects than melatonin.

Abstract:AIM: To investigate the clinical signs of blepharokeratoconjunctivitis (BKC) and evaluate the efficacy of penetrating keratoplasty (PKP) for the disease. METHODS: Sixteen patients (16 eyes) with BKC complicated by corneal perforation hospitalised at Shandong Eye Hospital were retrospectively analyzed. All patients received PKP. Participants were assessed for symptoms, clinical manifestations, the activity and damage grading of BKC. A paired t-test was used to compare the uncorrected visual acuity (UCVA) before and after surgery for the perforated eye. RESULTS: The mean age of the patients was 16.3y. Blurred vision is the most common discomfort, followed by redness, and then photophobia. The duration of ocular discomfort lasted for 3.2y, on average. Three (18.8%) participants were associated with rosacea, while 11 (68.8%) patients had recurrent chalazion or hordeolum. Demodex in eyelash follicles was positive in 11 (68.8%) cases. All corneal perforations were ≤3.0 mm in diameter. The perforation was located mainly in the inferior cornea (68.8%). The mean area of corneal vascularisation was 3.0 quadrants. All patients manifested bilateral BKC, with the perforated eyes ranked as severely damaged and presenting with severe inflammation. Most contralateral eyes manifested mild damage with no active inflammation. Majority (68.8%) of the perforated eyes were treated with PKP using a minimal graft. The UCVA increased significantly at the final follow-up (mean, 21mo; P<0.001), with the manifestation of BKC alleviated greatly. None of the patients developed immune rejection or other serious complications. CONCLUSION: BKC combined with corneal perforation occurs mainly among young people with a long history of ocular discomfort. PKP, especially using a minimal graft, is an effective and safe option for treating the disease.

Abstract:AIM: To isolate and identify the conjunctival microbiota of cataract patients and analyze the associated influencing factors. METHODS: This study recruited 216 participants (216 eyes) from April 2022 to July 2022. Under the condition of no antibiotic use prior to cataract surgery, sterile swabs were used to collect samples from the lower conjunctival sac. Bacterial cultures were then conducted, followed by species identification through 16S rDNA gene sequencing. Clinical factors associated with positive or negative bacterial isolation rates were analyzed, including age, gender, meibomian gland dysfunction (MGD), history of hypertension, history of diabetes, history of cancer, history of infectious diseases and the habit of wearing masks. RESULTS: Among the 216 eyes, 78 eyes yielded isolates, with an isolation rate of 36.11%, detecting a total of 122 strains. Gram-positive rods accounted for 49.18% (60 strains), gram-positive cocci accounted for 45.08% (55 strains), gram-negative bacteria accounted for 4.92% (6 strains), and fungi accounted for 0.82% (1 strain). This study found that the most abundant genera in the conjunctival sac were Corynebacterium (42.62%), Staphylococcus (31.15%), Micrococcus (9.84%), Acinetobacter (4.10%), and Bacillus (3.28%). Furthermore, age (P=0.006), gender (P=0.039), diabetes (P=0.003), history of infectious diseases (P=0.02), and duration of mask replacement (P<0.001) were important factors influencing the positive bacterial culture of the conjunctival microbiota. Although hypertensive patients exhibited a higher isolation rate of conjunctival bacteria, it did not reach statistical significance, and the history of cancer did not affect the isolation rate of the conjunctival microbial community in cataract patients before surgery. CONCLUSION: Potential changes are observed in the conjunctival microbiota among a sample of middle-aged and elderly individuals from Beijing, China. Notably, an increased isolation rate of Corynebacterium and Micrococcus is detected, suggesting a possible change in the microbial balance that requires further investigation and attention from the ophthalmological community. Advanced age, female gender, MGD, diabetes, a recent history of infectious diseases, and inadequate mask-wearing habits are potentially significant factors associated with the conjunctival microbiota. These factors should be considered in the development of strategies to prevent perioperative infections in cataract surgery patients.

Abstract:AIM: To investigate the clinical profile of patients with acquired lacrimal sac mucocele (ALSM) and evaluate the efficacy of endoscopic dacryocystorhinostomy (En-DCR) for this condition. METHODS: En-DCRs were performed on 141 patients with ALSM patients from January 2016 to March 2022. The clinical baseline information and magnetic resonance imaging (MRI) images were recorded and summarized. To assess the effectiveness of En-DCR therapy, both anatomical and functional success rate was assessed during a 12mo follow-up. RESULTS: A total of 141 patients, with a mean age of 57.70±14.11y, were enrolled in this study. Majority of the patients were female (n=91; 64.54%) and all had unilateral disease. All patients had a previous history of epiphora and purulent secretion, and the duration from lacrimal duct obstruction to mucocele formation ranged from 6 to 120mo. MRI findings consistently revealed an enlarged sac diameter, fluid accumulation separated by a thin rim from adjacent tissues, which is indicative of lacrimal sac mucocele. En-DCR was performed with an anatomical success rate of 93.62% and a functional success rate of 81.56%. CONCLUSION: ALSM is more commonly seen in females and unilaterally. It is essentially a complication of lacrimal duct obstruction. MRI characteristics can be used for precise clinical diagnosis, while En-DCR emerges as an optimal therapy for this condition. Our results provide a comprehensive reference for the diagnosis and treatment of ALSM.

Abstract:AIM: To describe the anatomic characteristics of the lacrimal sac and its adjacent bone structures and to provide surgical recommendations for endoscopic dacryocystorhinostomy (EN-DCR). METHODS: This retrospective comparative study involved 118 sides with complete nasolacrimal duct obstruction and 83 unaffected sides from 126 patients. Computed tomographic-dacryocystography (CT-DCG) scans were performed before lacrimal surgery, and image reconstruction was used to obtain continuous 0.75-mm axial, coronal, and segmental sections for review. The morphology of the lacrimal sac and its relationship with adjacent bony structures were determined for measurement, as well as the obstructed location. RESULTS: The height of the lacrimal sac was 12.99±2.10 mm in this study. The operculum of the middle turbinate (OMT) was located vertically in the lower third of the lacrimal sac. Horizontally, the junction between the maxillary bone and the lacrimal bone (MB-LB) was close to, mostly (60.2%) posterior to, the lacrimal sac. The uncinate process was more frequently attached to the lacrimal bones (75.1%). The obstructions were generally located around the entrance of the nasolacrimal duct (NLD). However, some were placed higher, with 7.63% blocked not lower than the OMT. There was a negative correlation between the diameter of the lacrimal sac and the level of obstruction (r= -0.35, P<0.01). CONCLUSION: In this study, the OMT and MB-LB can be served as the landmarks in EN-DCR. Partial uncinectomy should be performed in most cases. The obstructions were generally located around the entrance of the NLD, but some extreme individual variations strongly implies the importance of CT-DCG scanning before surgery.

Abstract:AIM: To elucidate the neuropathological mechanisms underlying diabetic vitreous hemorrhage (DVH) and its correlation with clinical characteristics. METHODS: Twenty-one individuals with DVH (male/female 12/9; mean age 52.29±11.66y) were selected, alongside 21 appropriately matched controls with diabetes mellitus (DM). Voxel-based morphometry (VBM) techniques were employed to identify aberrant functional regions in the brain. Receiver operating characteristic (ROC) curves were utilized for classification based on the average VBM values of the two groups, and Pearson correlation analysis was conducted to assess the relationship between average VBM values in distinct brain regions and clinical manifestations. RESULTS: Relative to the DM controls, DVH patients exhibited reduced VBM values in the right superior temporal pole, the right superior temporal gyrus, the right medial orbital frontal gyrus, and the left superior frontal gyrus. Furthermore, ROC curve analysis of these four brain regions in DVH patients demonstrated a high degree of accuracy, as indicated by the area under the curve. The average VBM value in each of these regions exhibited a negative correlation with both the duration of DVH and the score on the Hospital Anxiety and Depression Scale (HADS). CONCLUSION: Pathological alterations in four distinct brain regions are observed in patients with DVH, potentially reflecting neuropathological changes associated with this condition.

Abstract:AIM: To report the one-year surgical outcome Kahook Dual Blade goniotomy combined with phacoemulsification (KDB-Phaco) in Chinese patients with primary open angle glaucoma (POAG). METHODS: This is a retrospective study included 43 eyes of 28 Chinese POAG patients with cataract who accepted KDB-Phaco and followed-up for 12mo. Intraocular pressure (IOP), glaucoma medications and surgical complications were recorded. Success 1 and success 2 was defined as 5-21 mm Hg and 5-18 mm Hg, and success plus was determined if additional criteria of IOP reduction ≥20% from baseline was reached. A corrected IOP by adding 3 mm Hg for each medication was used to do correlation test. Cox’s proportional hazards regression model was used to test the hazard ratio for factors associated with surgical success. RESULTS: After a 12-month follow up, the IOP decreased from 28.1±6.3 to 13.8±3.0 mm Hg (47.92% reduction, P<0.001), and the medications used decreased from 2.0 (1.0) to 0.0 (0.0) (95% reduction, P<0.001). The mean IOP of all postoperative visits were lower than preoperative IOP (all P<0.001), so as the number of glaucoma medications (all P<0.001). Complete success 1 and qualified success 1 were 87.80% and 100.00% respectively. The complete success 1 plus and qualified success 1 plus were 85.37% and 97.56%, respectively. Totally 82.93% and 90.24% of patients got complete success 2 and qualified success 2 while 80.49% and 87.80% of patients satisfied complete success 2 plus and qualified success 2 plus. Age (r=-0.511, P=0.001) and visual acuity (VA; r=-0.321, P=0.041) were negatively correlated with postoperative corrected IOP at 12mo, while anterior chamber depth (r=0.432, P=0.005), mean deviation (r=0.617, P<0.001) and visual field index (r=0.524, P<0.001) were positively correlated with it. Preoperative VA (OR=33.092, P=0.004) and MD (OR=1.481, P=0.018) were hazard factors associated with failure based on qualified success as 18 mm Hg. The main complications of KDB were hyphema (9.30%), IOP spike (11.63%) and peripheral anterior synechia (6.98%). CONCLUSION: KDB goniotomy is a safe and effective in the treatment for Chinese POAG patients. Preoperative VA and mean deviation may predict the surgical success.

Abstract:AIM: To explore the morphological and functional parameters to evaluate the effectiveness of intravitreal injections of ranibizumab (IVR) in treating macular edema (ME) secondary to retinal vein occlusion (RVO). METHODS: This retrospective study involved 65 RVO patients (65 eyes) who received IVR and were followed-up for more than 3mo. ME was categorized into cystoid macular edema (CME), diffuse retinal thickening (DRT), and serous retinal detachment (SRD) according to optical coherence tomography (OCT) images. The comparison of best corrected visual acuity (BCVA; logMAR) and central macular thickness (CMT) among different follow-up points and those among 3 groups were performed by Kruskal-Wallis test. The correlation between BCVA and baseline parameters during treatment was analyzed using Spearman correlation analysis. RESULTS: BCVA tended to improve in all groups, with marked improvement in CME and DRT groups. CMT showed the greatest reduction after 1wk, and remained stable over the following 3mo. DRT patients had the worst BCVA and the highest CMT at baseline, but the differences became smaller after IVR treatment. CMT in SRD group was significantly better than in CME and DRT groups 3mo after IVR. Most patients of CME and SRD groups transitioned to a normal pattern at 3mo follow-up. DRT patients were most likely to transform into the other morphological groups, while SRD patients showed minimal transitions. BCVA at baseline was identified as the most important prognostic indicator in all 3 groups. Additionally, DRT patients with a longer clinical course, higher CMT and central retinal vein occlusion (CRVO) tend to exhibit worse BCVA after treatment. In addition, CRVO patients are more likely to have worse BCVA at 2 and 3mo follow-up compared with branch retinal vein occlusion (BRVO) patients in CME group. SRD patients with higher baseline CMT were prone to experiencing worse BCVA after treatment. CONCLUSION: The effectiveness of IVR is strongly correlated with baseline BCVA in all 3 groups. Baseline parameters including clinical course, CMT, and RVO position are also useful in predicting the BCVA at different time points after treatment.

Abstract:AIM: To examine the subclinical alterations in the retina and choroid between patients with 2019 coronavirus disease (COVID-19)-related lung involvement and the healthy control group. METHODS: In this prospective case-control study, 85 cases with lung involvement due to COVID-19 and 50 healthy cases were included. Best-corrected visual acuity, intraocular pressure measurement, and anterior and posterior segment examination were performed on both eyes for each individual. Choroidal and retinal changes were examined and recorded by optical coherence tomography angiography. RESULTS: All choroidal thickness measurements of the COVID-19 group showed no statistically significant difference when compared to healthy individuals. When vascular density and perfusion density values were compared, there was a decrease in the average of these values in the COVID-19 group, although it was not statistically significant (P=0.088, P=0.065 respectively). When the fovea avascular zone (FAZ) area values were compared, the average was 0.57±0.38 in the COVID-19 group, while it was 0.54±0.24 in the control group. CONCLUSION: Although our data are not statistically significant, the decrease in vascularity and perfusion and the accompanying FAZ expansion are detected in the acute period (1st month). These changes may anatomically alter the retina in the long term and affect functional vision. Future ischemia-related alterations in the retina caused by a prior COVID-19 infection may arise in situations without comorbidities and may require concern in the patient’s systemic assessment.

Abstract:AIM: To determine the risk factors and time to non-arteric ischemic optic neuropathy (NAION) occurrence among Thai type 2 diabetes mellitus (T2DM) patients. METHODS: A retrospective review of 266 newly diagnosed T2DM cases at Rajavithi Hospital between 2007 and 2016 was conducted to determine time to occurrence of NAION and evaluate associated risk factors. RESULTS: Hypertension and dyslipidemia were the most common pre-existing vascular diseases and there was a significant male predominance in the NAION group. The mean age of the NAION group was significantly higher than that of the group without NAION. A higher proportion of subjects in the NAION group had hypertension, dyslipidemia, high diastolic blood pressure, smokers, and had a small cup-to-disc ratio (CDR). Higher levels of triglycerides and low-density lipoprotein-cholesterol in the group with NAION. Fifty-five patients among 266 participants (20.68%) developed NAION during a mean follow-up time of 81.26±25.04mo. In a multivariable logistic regression analysis, dyslipidemia (OR=8.36, 95%CI, 3.447–20.273, P<0.001), high low density lipoprotein levels (OR=1.017, 95%CI, 1.004–1.029, P=0.009), and small CDR (OR=11.92, 95%CI, 4.477–31.741, P<0.001) were significant risk factors for NAION development. Smoking was the strongest predictive risk (OR=12.843, 95%CI, 3.959–41.659, P<0.001). Vascular complications of T2DM and aspirin were not associated with NAION. CONCLUSION: T2DM patients with dyslipidemia or a small CDR should be carefully followed up as they are at increased risk of developing NAION.

Abstract:AIM: To analyze whether alterations of voxel mirror homology connectivity (VMHC) values, as determined by resting-state functional magnetic resonance imaging (rs-fMRI), occur in cerebral regions of patients with hypertensive retinopathy (HR) and to determine the relationship between VMHC values and clinical characteristics in patients with HR. METHODS: Twenty-one patients with HR and 21 age-matched healthy controls (HCs) were assessed by rs-fMRI scanning. The functional connectivity between the hemispheres of the cerebrum was assessed by measuring VMHC, with the ability of VMHC to distinguish between the HR and HC groups assessed using receiver operating characteristic (ROC) curve analysis. Differences in the demographic and clinical characteristics of the HR and HC groups were analyzed by independent sample t-tests. The relationship between average VMHC in several brain areas of HR patients and clinical features was determined using Pearson correlation analysis. RESULTS: Mean VMHC values of the bilateral cuneus gyrus (BA19), bilateral middle orbitofrontal gyrus (BA47), bilateral middle temporal gyrus (BA39) and bilateral superior medial frontal gyrus (BA9) were lower in the HR than in the HC group. CONCLUSION: VMHC values can predict the development of early HR, prevent the transformation of hypertensive microangiopathy, and provide useful information explaining the changes in neural mechanism associated with HR.

Abstract:AIM: To investigate the underlying factors by establishing a new paradigm for assessing control ability under stereopsis testing conditions. METHODS: This was a prospective observational study. We evaluated the control ability of intermittent exotropia (IXT) patients in three conditions: natural 2D optotype viewing, 2D optotype viewing with polarized glasses, and 3D optotype viewing with polarized glasses. Recording with a smartphone, we captured videos to analyze the accurate time of spontaneous exodeviation and subsequent realignment before and after breaking fusion. Additionally, the correlation of stereopsis were also analyzed. RESULTS: A total of 48 patients (age range: 4-33y; 54.17% male) participated in the study. When viewing 3D optotypes with polarized glasses, their median control scores were 1 (interquartile range, 0-4) at distance and 0 (0-1) at near. These scores were significantly better than those observed under natural viewing conditions, which were 2.5 (1-5) at a distance and 1 (0-3) at near (Friedman test, P=0.049). Furthermore, those subjects who exhibited exophoria (realignment within 2 seconds) while viewing 3D optotypes with polarized glasses were more likely to have measurable stereo vision (Kendall’s τb=-0.344, P=0.018). CONCLUSION: IXT patients exhibit enhanced control ability when using polarized glasses to view 3D optotypes, notably improving realignment capabilities. This expands our understanding of current tests and offers a potentially sensitive method for assessing IXT severity.

Abstract:AIM: To assess the visual electrophysiological outcomes in children with functional amblyopia who exhibited poor response to conventional treatment. METHODS: Twenty-one children with functional amblyopia, aged 5.7±2.1y (range: 4-10y), underwent comprehensive ophthalmic and refractive evaluations. Spectral domain-optical coherence tomography (SD-OCT) and multifocal electroretinography (mfERG) were conducted to analyze the macular retinal thickness and the first-order response P1 ring of the mfERG in the amblyopic eye (AE) compared to the fellow good eye (GE). RESULTS: Initially, visual acuity in the AE ranged from 20/800 to 20/40, while the GE exhibited a range of 20/25 to 20/20 (P<0.01). After 6mo of treatment, 17 patients demonstrated improved visual acuity in the AE to 20/50 or better, while 4 children showed no improvement. SD-OCT revealed comparable macular and optic disc structures between the AE and GE. Prior to treatment, the mfERG P1 ring amplitude was significantly reduced in the AE compared to GE (P<0.05). The AE/GE ratio of P1 ring amplitude showed significant improvement post-treatment. However, a smaller AE/GE ratio before treatment was associated with poorer improvement post-treatment. CONCLUSION: In the management of functional amblyopia, a thorough assessment of amblyopic eye examinations is crucial. Approximately 20% of amblyopic eyes may not achieve significant improvement in visual acuity, despite the absence of detectable organic retinal abnormalities. mfERG may reveal underlying abnormalities. Integrating mfERG into initial assessments or treatment follow-ups can aid in identifying potential hidden retinal defects and predicting the prognosis of the amblyopic eye.

Abstract:AIM: To investigate the potential mechanisms of A-V pattern and evaluate the surgical outcomes used in the treatment of sensory exotropia. METHODS: The medical records of patients with sensory A-V pattern exotropia who underwent strabismus surgery between May 2014 to June 2019 was retrospectively reviewed. The control group included sensory exotropia patients without A-V pattern and concomitant A-V pattern exotropia patients with normal vision who undergone strabismus surgery over this same time period. Ocular alignment, best corrected visual acuity, oblique muscle function, and stereopsis records were collected. RESULTS: Among the 843 eligible patients, 91 (10.79%; 39 males and 52 females) had A-pattern (54, 6.4%) or V-pattern (37, 4.4%). Age at onset of vision impairment was 4±5y and at the time of surgery was 25±9y. Statistically significant negative correlations were present between impaired visual acuity and the pre-operative exodeviation (r=-0.198, P=0.016) and patterns (r=-0.207, P=0.015). Age at surgery and exodeviation in patients with concomitant A-V pattern exotropia was significantly earlier as compared with that of sensory A-V pattern exotropia and sensory exotropia (both P<0.0001). There were no significant differences in these clinical variables between sensory exotropia with or without A-V pattern. Deviation and pattern were significantly reduced in patients receiving horizontal rectus surgery with or without oblique muscle surgery (both P<0.0001). CONCLUSION: The prevalence of sensory A-V pattern exotropia in our study is 10.79%. Visual acuity represents an important factor contributing to the occurrence and development of A-V pattern. Isolated horizontal rectus surgery can provide a good option for the correction of sensory A-V pattern exotropia.

Abstract:AIM: To evaluate the characteristics of exotropia (XT) and motor-sensory outcomes after surgical correction and to determine the factors associated with sensory outcomes of XT surgery. METHODS: The medical records of all patients that were diagnosed with XT and underwent strabismus surgery in 13 major government hospitals in Thailand; from January 2012 to December 2019, were retrospectively reviewed. Univariable and multivariable logistic regression were performed to identify factors related to binocular vision. RESULTS: Data of five hundred and thirty-seven patients were analyzed. Two hundred and twenty-six patients were men (42.1%). The median age of onset was 3 years old [Interquartile range (IQR): 1, 8]. The median age at diagnosis was 9.21 years old (IQR; 4.64, 21.06). intermittent exotropia [X(T)] was the most common type (52.1%); 19.5% of the patients had amblyopia. For refractive error, spherical equivalent refraction on right eye (RE) and left eye (LE) were -0.53±2.45 diopters (D) (range -14.88 to +10 D) and -0.48±2.37 D (range -19.50 to +7.75 D), respectively. The mean angle of deviation at distance and near before surgery were 42.06±14.91 prism diopters (PD) and 40.81±16.09 PD, respectively. Follow-up time after first operation was 2.48±2.27y. Four hundred sixty-two patients (86%) needed only one operation and 299 (55.6%) patients had bilateral lateral rectus recession. At final visit, the mean angles of deviation at distance and near decreased to 5.76±8.96 PD and 5.01±8.73 PD, respectively. After surgery, two hundred seventy-three patients (50.8%) were evaluated for binocular function, but the others did not have result. From multivariable logistic regression in 273 patients, the factors related to better binocular function were type of XT which was X(T) [adjusted odds ratio (aOR) 10.35; 95%CI: 4.73, 22.66] compared to constant XT, without amblyopia (aOR 3.97; 95%CI: 1.84, 8.53), underwent only single operation compared with more than 1 operation (aOR 3.80, 95%CI: 1.58, 9.16), the angle of deviation at near in last visit less than 10 PD better than 10–30 PD with aOR 0.42 (95%CI: 0.18, 0.96) and type of refraction revealed isometropia better than anisometropia with aOR 4.13 (95%CI: 1.19, 14.32). CONCLUSION: The surgical outcomes of XT within one operation in Thailand is 86%. The factors related to achieve binocular function includes type of XT as X(T), without amblyopia, angle of deviation at final visit less than 10 PD, isometropia type of refraction and underwent only one surgical correction.

Abstract:The methylation of DNA is a prevalent epigenetic modification that plays a crucial role in the pathological progression of ocular diseases. DNA methylation can regulate gene expression, thereby affecting cell function and signal transduction. Ophthalmic diseases are a kind of complex diseases, and their pathogenesis involves many factors such as genetic, environmental and individual differences. In addition, inflammation, oxidative stress and lipid metabolism, which abnormal DNA methylation is closely related to, are also considered to be major factors in eye diseases. The current understanding of DNA methylation in eye diseases is becoming more complex and comprehensive. In addition to the simple suppression of gene expression by hypermethylation, factors such as hypomethylation or demethylation, DNA methylation in non-promoter regions, interactions with other epigenetic modifications, and dynamic changes in DNA methylation must also be considered. Interestingly, although some genes are at abnormal methylation levels, their expression is not significantly changed, which indirectly reflects the complexity of gene regulation. This review aims to summarize and compare some relevant studies, and provide with new ideas and methods for the prevention and treatment of different eye diseases, such as glaucoma, retinoblastoma, and diabetic retinopathy.

Abstract:Photobiomodulation has been known to have potential medicinal effects for ages. It involves the use of specific wavelengths to target specific regions in the cell. Different health conditions have been reported to be treated with exposure to light such as cardiovascular conditions, inflammatory diseases, infectious diseases, and most importantly ocular diseases. This review specifically targets the treatment of retinal diseases including age-related macular degeneration, diabetic macular edema, myopia and acute retinal light injury with photobiomodulation. Red light is used in this therapy since this wavelength has lower frequency and hence minimal chance of causing any damage. Red light has the potential to penetrate cellular structures such as mitochondria and facilitate cellular processes. For ocular diseases, the target wavelength ranges between 630 to 800 nm. In most of the cases the primary target for red light is the cytochrome C oxidase enzyme in mitochondria, which alters the gene expression and promotes cellular energy production. Clinical evidence shows improvement of visual activity and reduction in thickness of retina post treatment. Future prospects of photobiomodulation involve target-specific treatment, combinational therapy to treat complex retinal diseases including gene therapy, and longitudinal studies to predict long-term efficacy and the chance of any recurrence in the patients. Hence the future of photobiomodulation holds significant potential in medicine especially in ocular diseases characterized by progress in research, technology, and clinical trials.

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