Volume 10,Issue 11,2017 Table of Contents

1 DNA vaccine expressing herpes simplex virus 1 glycoprotein C and D protects mice against herpes simplex keratitis

Li-Li Dong , Ru Tang , Yu-Jia Zhai , Tejsu Malla , Kai Hu

2017, 10(11):1633-1639. DOI: 10.18240/ijo.2017.11.01

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Abstract:
AIM: To investigate whether DNA vaccine encoding herpes simplex virus 1 (HSV-1) glycoprotein C (gC) and glycoprotein D (gD) will achieve better protective effect against herpes simplex keratitis (HSK) than DNA vaccine encoding gD alone. METHODS: DNA vaccine expressing gD or gC combined gD (gD.gC) were constructed and carried by chitosan nanoparticle. The expression of fusion protein gD and gC were detected in DNA/nanoparticle transfected 293T cells by Western-blot. For immunization, mice were inoculated with DNA/nanoparticle for 3 times with 2wk interval, and two weeks after the final immunization, the specific immune responses and clinical degrees of primary HSK were evaluated. RESULTS: Fusion protein gD.gC could be expressed successfully in cultured 293T cells. And, pRSC-gC.gD-IL21 DNA/chitosan nanoparticle could effectively elicit strongest humoral and cellular immune response in primary HSK mice evidenced by higher levels of specific neutralizing antibody and sIgA production, enhanced cytotoxicities of splenocytes and nature killer cells (NK), when compared with those of gD alone or mocked vaccine immunized mice. As a result, gC-based vaccine immunized mice showed least HSK disease. CONCLUSION: gC-based DNA vaccine could effectively prevent the progress of primary HSK, suggesting that this DNA vaccine could be a promising vaccine for HSK treatment in the future.

2 Histopathologic findings of keratoconus corneas underwent penetrating keratoplasty according to topographic measurements and keratoconus severity

Mohammad Naderan , Ali Jahanrad , Siavash Balali

2017, 10(11):1640-1646. DOI: 10.18240/ijo.2017.11.02

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Abstract:
AIM: To investigate the histopathologic and morphological changes of the corneas with keratoconus (KC) undergoing penetrating keratoplasty (PKP) according to topographic findings and severity of KC. METHODS: The corneal tissue of 35 samples with KC was retrospectively evaluated with conventional light microscopy. Topographic and pachymetric parameters of keratoconus corneas by means of Pentacam such as mean keratometry (K) and central corneal thickness (CCT) were recorded. Severity of KC was graded according to Amsler-Krumeich classification. RESULTS: Epithelial thinning and breaks in Bowman’s layer are the most common findings in keratoconus corneas (94.3% and 82.9% corneas, respectively). The results revealed statistically significant higher mean K value and lower CCT in the keratoconus corneas that were affected by epithelial thinning, breaks in the Bowman's layer, folds in the Descemet's membrane, epithelial scars, breaks in Descemet's membrane, and stromal scars than those corneas without these findings (P<0.05). Moreover, those corneas with epithelial thinning, breaks in the Bowman's layer, folds in Descemet's membrane, epithelial scars, and stromal scars had significantly more severe disease than those corneas without these findings (P<0.05). The presence of the stromal and epithelial scars were associated with the higher KC severity, in which, respectively, 87.5% and 80.0% of the corneas with stromal and epithelial scars had stage 4 of the KC severity. CONCLUSION: It seems that there are some specific patterns in histologic changes of the keratoconus corneas. The presence of pathologic findings was correlated with thinner and steeper corneas. Epithelial or stromal scars were associated with the highest disease severity. The description of histopathologic findings of KC may help in elucidating the pathogenesis of the disease and help pathologist in differentiating KC from other corneal diseases.

3 Effect of itraconazole on the cornea in a murine suture model and penetrating keratoplasty model

Yang Kyung Cho , Eun Young Shin , Hironori Uehara , Balamurali Ambati

2017, 10(11):1647-1654. DOI: 10.18240/ijo.2017.11.03

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Abstract:
AIM: To investigate the anti-(lymph)angiogenic and/or anti-inflammatory effect of itraconazole in a corneal suture model and penetrating keratoplasty (PK) model. METHODS: Graft survival, corneal neovascularization, and corneal lymphangiogenesis were compared among itraconazole, amphotericin B, dexamethasone, phosphate buffered saline (PBS) and surgery-only groups following subconjunctival injection in mice that underwent PK and corneal suture. Immunohistochemical staining and analysis were performed in each group. Real-time polymerase chain reaction (RT-PCR) was performed to quantify the expression of inflammatory cytokines (TNF-alpha, IL-6) and vascular endothelial growth factor (VEGF)-A, VEGF-C, VEGFR-2, and VEGFR-3. RESULTS: In the suture model, the itraconazole group showed less angiogenesis, less lymphangiogenesis, and less inflammatory infiltration than the PBS group (all P<0.05). The itraconazole group showed reduced expression of VEGF-A, VEGFR-2, TNF-alpha, IL-6 than the PBS group (all P<0.05). In PK model, the two-month graft survival rate was 28.57% in itraconazole group, 62.50% in dexamethasone group, 12.50% in PBS group, 0 in amphotericin B group and 0 in surgery-only group. Graft survival in the itraconazole group was higher than that in the amphotericin, PBS and surgery-only group (P=0.057, 0.096, 0.012, respectively). The itraconazole group showed less total angiogenesis and lymphangiogenesis than PBS group (all P<0.05). CONCLUSION: Itraconazole decrease neovascularization, lymphangiogenesis, and inflammation in both a corneal suture model and PK model. Itraconazole has anti-(lymph)-angiogenic and anti-inflammatory effects in addition to its intrinsic antifungal effect and is therefore an alternative treatment option in cases where steroids cannot be used.

4 Expression of multidrug resistance proteins in retinoblastoma

Swati Shukla , Arpna Srivastava , Sunil Kumar , Usha Singh , Sandeep Goswami , Bhavna Chawla , Mandeep Singh Bajaj , Seema Kashyap , Jasbir Kaur

2017, 10(11):1655-1661. DOI: 10.18240/ijo.2017.11.04

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Abstract:
AIM: To elucidate the mechanism of multidrug resistance in retinoblastoma, and to acquire more insights into in vivo drug resistance. METHODS: Three anticancer drug resistant Y79 human RB cells were generated against vincristine, etoposide or carboplatin, which are used for conventional chemotherapy in RB. Primary cultures from enucleated eyes after chemotherapy (PCNC) were also prepared. Their chemosensitivity to chemotherapeutic agents (vincristine, etoposide and carboplatin) were measured using MTT assay. Western blot analysis was performed to evaluate the expression of p53, Bcl-2 and various multidrug resistant proteins in retinoblastoma cells. RESULTS: Following exposure to chemotherapeutic drugs, PCNC showed less sensitivity to drugs. No significant changes observed in the p53 expression, whereas Bcl-2 expression was found to be increased in the drug resistant cells as well as in PCNC. Increased expression of P-glycoprotein (P-gp) was observed in drug resistant Y79 cells; however there was no significant change in the expression of P-gp found between primary cultures of primarily enucleated eyes and PCNC. Multidrug resistance protein 1 (Mrp-1) expression was found to be elevated in the drug resistant Y79 cells as well as in PCNC. No significant change in the expression of lung resistance associated protein (Lrp) was observed in the drug resistant Y79 cells as well as in PCNC. CONCLUSION: Our results suggest that multidrug resistant proteins are intrinsically present in retinoblastoma which causes treatment failure in managing retinoblastoma with chemotherapy.

5 Protective effect of pomegranate juice on retinal oxidative stress in streptozotocin-induced diabetic rats

Betul Tugcu , Senay Asik Nacaroglu , Asuman Gedikbasi , Mehmet Uhri , Nur Acar , Hakan Ozdemir

2017, 10(11):1662-1668. DOI: 10.18240/ijo.2017.11.05

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AIM: To investigate the effect of pomegranate juice (PJ) intake on overall oxidation status in retinas of diabetic rats. METHODS: Twenty-seven rats were divided into four groups as control (CO), diabetic (DM), control treated with PJ (CO-PJ), and diabetic treated with PJ (DM-PJ).The retina tissues were used to determine 8-hydroxy-2’-deoxyguanosine (8OHdG), malondialdehyde (MDA), reduced glutathione (GSH) levels, and the enzyme activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). RESULTS: The levels of 8OHdG and MDA were significantly increased in the retina of DM group compared to CO group (P=0.001, P<0.001 respectively). Both 8OHdG and MDA levels were decreased in PJ-DM group compared to DM group (P=0.004, P<0.001 respectively). The activities of antioxidant enzymes GSH, SOD, and GDH-Px were significantly decreased in the retina of DM group compared to CO group (P≤0.01). GSH and GSH-Px activities were higher in PJ-DM group compared with DM group (P=0.010, P=0.042, respectively) but SOD activity was not statistically different (P=0.938). CONCLUSION: PJ intake is found to be effective in decreasing oxidative end products, and in increasing the activities of antioxidant enzymes in diabetic retinas of rats, which suggests it may be effective against oxidative stress in diabetic retinas.

6 Effect of mistletoe combined with carboxymethyl cellulose on dry eye in postmenopausal women

Nan Jiang , Lin-Hong Ye , Lei Ye , Jing Yu , Qi-Chen Yang , Qing Yuan , Pei-Wen Zhu , Yi Shao

2017, 10(11):1669-1677. DOI: 10.18240/ijo.2017.11.06

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Abstract:
AIM: To investigate the protective effect of mistletoe combined with carboxymethyl cellulose eye drops on dry eye in postmenopausal women. METHODS: Sixty postmenopause female patients diagnosed of dry eye were assigned randomly to mistletoe combined with carboxymethyl cellulose eye drops treatment group (n=30) and control group treated with normal saline eye drops (n=30). The subjective symptoms of ocular surface, Ocular Surface Disease Index (OSDI), tear film function tests, tear protein and corneal morphology by confocal scanning microscopy were analyzed before treatment and at 1, 2, 4 and 8wk after treatment respectively. To ensure the safety of the trial, all patients were examined with systolic pressure, diastolic pressure, glutamic-pyruvic transaminase, glutamic oxaloacetic transaminase, urine creatinine, and blood urea nitrogen at 8wk after treatment. RESULTS: There were no obvious differences between two groups before the treatment (P>0.05). In two months after the treatment, the symptoms of ocular surface, OSDI, tear protein, and tear film function were only slightly changed in normal saline eye drops group. However, all indices were improved after the treatment of mistletoe combined with carboxymethyl cellulose eye drops group (P<0.05). In addition, the average amount of corneal epithelium basal cells and inflammatory cells of mistletoe treated group were 3174±379 and 38±25 cells/mm2, significantly decreased as compared to the control group with 4309±612 and 158± 61 cells/mm2, respectively. In the control group, although nerves still maintained straight under corneal epithelium, the number of nerves were significantly decreased, as compared with normal female. In the mistletoe treated group, the number of nerves was only slightly reduced, compared with normal female. CONCLUSION: Mistletoe combined with carboxymethyl cellulose eye drops can alleviate the symptoms and signs of dry eye symptoms.

7 Femtosecond laser corneal refractive surgery for the correction of high myopic anisometropic amblyopia in juveniles

Jing Zhang , Ke-Ming Yu

2017, 10(11):1678-1685. DOI: 10.18240/ijo.2017.11.07

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Abstract:
AIM: To evaluate the effects of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE) to correct high myopic anisometropic amblyopia in juvenile patients. METHODS: From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK (30 eyes) or SMILE (3 eyes) was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed follow-up examinations at 3d, 1mo, 3mo and the last follow-up time (mean 8.17±3.23mo) after surgery. RESULTS: The mean age at surgery was 9.04±3.04y (range 6-16y). The mean spherical equivalent in the amblyopic eyes was significantly decreased from -10.00±2.39 D preoperatively to -0.06±1.06 D at 1mo, -0.19±1.33 D at 3mo and -0.60±1.43 D at approximately 8mo postoperatively (P<0.05 for all). The mean myopic anisometropia was significantly decreased from -9.45±2.33 D preoperatively to +0.37±1.48 D at 1mo, -0.46±1.47 D at 3mo and -0.09±1.83 D at approximately 8mo (P<0.05 for all). The logarithm of the minimum angle of resolution (logMAR) for uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8mo after surgery, respectively. The logMAR CDVA at 3d, 1, 3 and 8mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles per degree was significantly improved postoperatively (P<0.05 for all). Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients (21.2%) recovered near stereopsis (400″ to 60″) at approximately 8mo after surgery. No intraoperative or postoperative complications occurred in any patient. CONCLUSION: FS-LASIK or SMILE can be promising alternative methods to correct high myopic anisometropic amblyopia in juvenile patients who have failed with traditional approaches.

8 Scanning-slit topography in patients with keratoconus

László Módis Jr. , Gábor Németh , Eszter Szalai , Zsuzsa Flaskó , Berthold Seitz

2017, 10(11):1686-1692. DOI: 10.18240/ijo.2017.11.08

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Abstract:
AIM: To evaluate the anterior and posterior corneal surfaces using scanning-slit topography and to determine the diagnostic ability of the measured corneal parameters in keratoconus. METHODS: Orbscan II measurements were taken in 39 keratoconic corneas previously diagnosed by corneal topography and in 39 healthy eyes. The central minimum, maximum, and astigmatic simulated keratometry (K) and anterior axial power values were determined. Spherical and cylindrical mean power diopters were obtained at the central and at the steepest point of the cornea both on anterior and on posterior mean power maps. Pachymetry evaluations were taken at the center and paracentrally in the 3 mm zone from the center at a location of every 45 degrees. Receiver operating characteristic (ROC) analysis was used to determine the best cut-off values and to evaluate the utility of the measured parameters in identifying patients with keratoconus. RESULTS: The minimum, maximum and astigmatic simulated K readings were 44.80±3.06 D, 47.17±3.67 D and 2.42±1.84 D respectively in keratoconus patients and these values differed significantly (P<0.0001 for all comparisons) from healthy subjects. For all pachymetry measurements and for anterior and posterior mean power values significant differences were found between the two groups. Moreover, anterior central cylindrical power had the best discrimination ability (area under the ROC curve=0.948). CONCLUSION: The results suggest that scanning-slit topography and pachymetry are accurate methods both for keratoconus screening and for confirmation of the diagnosis.

9 Phacoemulsification combined with transpupillary removal of silicone oil and intracapsular intraocular lens implantation

Yu-Cheng Zhu , Dong-Qing Yuan , Ping Xie , Xiao-Yi Liu , Song-Tao Yuan , Qing-Huai Liu

2017, 10(11):1693-1697. DOI: 10.18240/ijo.2017.11.09

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Abstract:
AIM: To estimate the effectiveness of phacoemulsification and foldable intraocular lens (IOL) implantation combined with transpupillary silicone oil removal. METHODS: There were 168 eyes of 168 candidate patients with cataract and silicone oil-filled eyes recruited in our study. All of the patients received the intraocular silicone oil removal surgery by transpupillary drainage and cataract extraction by phacoemulsi?cation. Then the IOL implantation were also performed through corneal incision. RESULTS: The surgery was successfully completed in all eyes. Best corrected visual acuity (BCVA) and postoperative complications were recorded in three months after surgery. There were 143 eyes with BCVA improved, otherwise 25 eyes remained stable at the last follow-up visit. The mean BCVA statistically improved from 20/400±0.02 to 20/100±0.15 (P<0.001) and mean postoperative IOP was 13.85±2.18 mm Hg (P=0.415). No intra-operative complications were reported. CONCLUSION: Phacoemulsi?cation combined with transpupillary removal of silicone oil is a safe and simple effective method. In general, it enables quick recovery of visual acuity with less complication rate.

10 Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes

Lawrence J. Oh , Chu Luan Nguyen , Eugene Wong , Samuel S.Y. Wang , Ian C. Francis

2017, 10(11):1698-1702. DOI: 10.18240/ijo.2017.11.10

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Abstract:
AIM: To evaluate surgical outcomes (SOs) and visual outcomes (VOs) in cataract surgery comparing the Centurion® phacoemulsification system (CPS) with the Infiniti® phacoemulsification system (IPS). METHODS: Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced® tip (n=207) or the IPS using the 30-degree Kelman® tip (n=205). Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS) grade, cumulated dissipated energy (CDE), preoperative corrected distance visual acuity (CDVA), and CDVA at one month were recorded. RESULTS: CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS (n=70) compared with IPS (n=44) (P=0.010). Surgical complications were not statistically different between the two subcohorts (P=0.083), but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs) at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5) in the CPS and -0.15 logMAR (6/4.5) in the IPS subcohort respectively (P=0.033). CONCLUSION: CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei.

11 Repeatability of Ophtha Top topography and comparison with IOL-Master and LenstarLS900 in cataract patients

Sha-Sha Yu , Hui Song , Xin Tang

2017, 10(11):1703-1709. DOI: 10.18240/ijo.2017.11.11

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Abstract:
AIM: To determine the repeatability of Ophtha Top topography and assess the consistency with intraocular lens (IOL)-Master and LenstarLS900 (Lenstar) in measuring corneal parameters among cataract patients. METHODS: Totally 125 eyes were enrolled. Corneas were successively measured with Ophtha Top, IOL-Master and Lenstar at least three times. The flattest meridian power (Kf), the steepest meridian power (Ks), mean power (Km), J0 and J45 were recorded. Intra-class correlation coefficients (ICCs), the coefficient of variance (COV), within subject standard deviation (Sw), and test-retest repeatability (2.77Sw) were adopted to determine the repeatability. The 95% limit of agreement (95%LOA) and Bland-Altman plots were used to assess comparability. RESULTS: Repeatability of Ophtha Top topography for measuring corneal parameters showed the ICCs were all above 0.93, 2.77Sw was lower than 0.31, and the COV of the Kf and Ks was lower than 0.25. The keratometric readings with Ophtha Top topography were flatter than with the IOL-Master and Lenstar devices, while the Pearson correlation coefficients were over 0.97. The J0 and J45 with Ophtha Top topography were smaller compared with Lenstar and IOL-Master, while was comparable between Lenstar and IOL-Master. CONCLUSION: Ophtha Top topography shows excellent repeatability for measuring corneal parameters. However, differences between the Ophtha TOP topography and Lenstar, IOL-Master both in cornea curvature and the astigmatism should be noted clinically.

12 Bimanual microincision cataract surgery with implantation of the new Incise® MJ14 intraocular lens through a 1.4 mm incision

Gian Maria Cavallini , Tommaso Verdina , Michele De Maria , Elisa Fornasari , Giulio Torlai , Veronica Volante , Simone Donati , Carlo Cagini

2017, 10(11):1710-1715. DOI: 10.18240/ijo.2017.11.12

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Abstract:
AIM: To analyze the visual outcomes and the posterior capsule opacification (PCO) with the new Incise® MJ14 intraocular lens (IOL) implanted through a 1.4 mm clear corneal incision (CCI) in patients who underwent bimanual microincision cataract surgery (B-MICS). METHODS: Eighty eyes which underwent cataract surgery using B-MICS technique performed by the same experienced surgeon were included in the study: 40 eyes were implanted with an Incise® MJ14 IOL through a 1.4 mm CCI (group A) without enlargement of the main CCI, while 40 eyes were implanted with an Akreos® MI60 IOL with enlargement of the main CCI to 1.8 mm (group B). Best corrected visual acuity (BCVA), astigmatism and endothelial cell loss were evaluated before and after surgery at 7, 30d and 6mo. Anterior segment-optical coherence tomography (AS-OCT) of CCI was performed at 1, 3, 7, 30d, 6 and 18mo. PCO incidence was evaluated at 18mo using EPCO 2000 Software. RESULTS: Mean BCVA improvement and endothelial cell loss were statistically significant at 18mo in both groups with no difference between the two groups; no statistically significant difference in surgically induced astigmatism (SIA) was noticed in the two groups. At AS-OCT the only significant alterations in the CCI were endothelial gaping and local detachment of Descemet’s membrane at 1 and 7d after surgery; no statistically significant alterations were found at 1, 6 and 18mo. PCO score at 18mo was 0.03±0.07 for group A and 0.08±0.18 for group B (P=0.11) with no sign of central optic plate invasion in both groups. CONCLUSION: The implant of the new Incise® MJ14 IOL through a 1.4 mm CCI and B-MICS technique appeared to be a safe and effective procedure with rapid visual recovery. PCO rate resulted very low and the CCI presented few morphological alterations which were only detectable in the first days postoperatively and achieved fast corneal healing during the long-term follow-up.

13 The prognostic value of lymphocyte-to-monocyte ratio in retinopathy of prematurity

Yu-Xiang Hu , Xiao-Xuan Xu , Yi Shao , Gao-Le Yuan , Feng Mei , Quan Zhou , Yi Cheng , Jun Wang , Xiao-Rong Wu

2017, 10(11):1716-1721. DOI: 10.18240/ijo.2017.11.13

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Abstract:
AIM: To evaluate the associations between development of retinopathy of prematurity (ROP) and serum lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). METHODS: A retrospective cohort study was performed, involving infants who were screened for ROP from January 2015 to December 2015. Preterm newborns of ≤32 gestational weeks with ROP were enrolled as the observation group, and non-ROP infants were enrolled as the control group, whose complete blood cell were measured within the first 24h of life. The levels of NLR, LMR and PLR were determined in all groups. The data obtained were analyzed using univariate and multivariate logistic regression analysis. RESULTS: In this study, 40 cases of ROP were enrolled and 40 cases of non-ROP as controls. The LMR levels were significantly higher (P<0.001) in ROP group (3.96±1.16) compared to non-ROP group (2.85±0.79). The NLR levels were significantly lower (P=0.035) in ROP group {median [interquartile range (IQR)], 0.88 (0.67-1.46)} compared to non-ROP group [median (IQR), 1.20 (0.85-1.89)]. The median PLR values were 61.99 (IQR, 50.23-75.98) in ROP group and 69.24 (IQR, 55.52-88.12) in non-ROP group (P=0.104). Logistic regression analysis suggested that LMR was an independent risk factor for ROP (OR: 0.275; 95% CI: 0.134-0.564; P=0.001). CONCLUSION: The findings demonstrate that higher LMR is independently and significantly associated with the development of ROP, and the LMR may be invoked as a predictive tool for identifying risk for ROP.

14 A predictive score for retinopathy of prematurity by using clinical risk factors and serum insulin-like growth factor-1 levels

Yeşim Coşkun , Ceyhun Dalkan , Özge Yabaş , Özlem ünay Demirel , Elif Samiye Bayar , Sibel Sakarya , Tuba Müftüoğlu , Dilaver Erşanlı , Nerin Bahçeciler , İpek Akman

2017, 10(11):1722-1727. DOI: 10.18240/ijo.2017.11.14

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Abstract:
AIM: To detect the impact of insulin-like growth factor-1 (IGF-1) and other risk factors for the early prediction of retinopathy of prematurity (ROP) and to establish a scoring system for ROP prediction by using clinical criteria and serum IGF-1 levels. METHODS: The study was conducted with 127 preterm infants. IGF-1 levels in the 1st day of life, 1st, 2nd, 3rd and 4th week of life was analyzed. The score was established after logistic regression analysis, considering the impact of each variable on the occurrences of any stage ROP. A validation cohort containing 107 preterm infants was included in the study and the predictive ability of ROP score was calculated. RESULTS: Birth weights (BW), gestational weeks (GW) and the prevalence of breast milk consumption were lower, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD) and necrotizing enterocolitis (NEC) were more frequent, the duration of mechanical ventilation and oxygen supplementation was longer in patients with ROP (P<0.05). Initial serum IGF-1 levels tended to be lower in newborns who developed ROP. Logistic regression analysis revealed that low BW (<1250 g), presence of intraventricular hemorrhage (IVH) and formula feeding increased the risk of ROP. Afterwards, the scoring system was validated on 107 infants. The negative predictive values of a score less than 4 were 84.3%, 74.7% and 79.8% while positive predictive values were 76.3%, 65.5% and 71.6% respectively. CONCLUSION: In addition to BW <1250 g and IVH, formula consumption was detected as a risk factor for the development of ROP. Breastfeeding is important for prevention of ROP in preterm infants.

15 Validity of automated refraction after segmented refractive multifocal intraocular lens implantation

César Albarrán-Diego , Gonzalo Muñoz , Stephanie Rohrweck , Santiago García-Lázaro , José Ricardo Albero

2017, 10(11):1728-1733. DOI: 10.18240/ijo.2017.11.15

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Abstract:
AIM: To evaluate the clinical utility of automated refraction (AR) and keratometry (KR) compared with subjective or manifest refraction (MR) after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH) refractive multifocal intraocular lens (IOL). METHODS: Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. RESULTS: Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D) for sphere. Astigmatism showed better correlation between KR and MR. CONCLUSION: We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.

16 The effect of cataract surgery on sleep quality: a systematic review and Meta-analysis

Ling Zheng , Xiao-Hang Wu , Hao-Tian Lin

2017, 10(11):1734-1741. DOI: 10.18240/ijo.2017.11.16

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Abstract:
AIM: To evaluate the effect of cataract surgery on sleep quality and to compare the difference between ultraviolet-blocking clear intraocular lens (UVB-IOL) and blue-filtering intraocular lens (BF-IOL) implantation. METHODS: Electronic search was performed of PubMed, MEDLINE, Embase and the Cochrane Library up to January 2016. Studies were eligible when they evaluated the sleep quality before and after cataract surgery by Pittsburgh sleep quality index (PSQI). A random/fixed-effects Meta-analysis was used for the pooled estimate. Heterogeneity was assessed with the I2 test. RESULTS: Six studies were selected from 5623 references. Cataract surgery significantly reduced the PSQI scores at postoperative 0-3mo [mean difference (MD) =-0.62, 95%CI: -1.14 to -0.11, P=0.02, I2=66%] and 3-12mo (MD=-0.32, 95%CI: -0.62 to -0.02, P=0.04, I2=0), respectively. Considering different intraocular lens (IOL) implantations, relative post-operative PSQI reduction was found for both UVB-IOL and BF-IOL, but a significant reduction was detected only for UVB-IOL. No significant difference was found with the effect of BF-IOL vs UVB-IOL on sleep quality. CONCLUSION: This study found that cataract surgery significantly improved the PSQI score-derived subjective sleep quality irrespective of the IOL type implanted. These findings highlight a substantial benefit of cataract surgery on systemic health with photoreceptive restoration in addition to visual acuity improvements.

17 Predictive factors of visual function recovery after pituitary adenoma resection: a literature review and Meta-analysis

Min Sun , Zhi-Qiang Zhang , Chi-Yuan Ma , Sui-Hua Chen , Xin-Jian Chen

2017, 10(11):1742-1750. DOI: 10.18240/ijo.2017.11.17

[Abstract](1697) [HTML](269) [PDF 1.76 M](837)

Abstract:
AIM: To determine the dominant predictive factors of postoperative visual recovery for patients with pituitary adenoma. METHODS: PubMed, Google Scholar, Web of Science and Cochrane Library were searched for relevant human studies, which investigated the prediction of the postoperative visual recovery of patients with pituitary adenoma, from January 2000 to May 2017. Meta-analyses were performed on the primary outcomes. After the related data were extracted by two independent investigators, pooled weighted mean difference (WMD) and odds ratio (OR) with 95% confidence interval (CI) were estimated using a random-effects or a fixed-effects model. RESULTS: Nineteen studies were included in the literature review, and nine trials were included in the Meta-analysis, which comprised 530 patients (975 eyes) with pituitary adenoma. For the primary outcomes, there was a significant difference between preoperative and postoperative mean deviation (MD) values of the visual field (WMD -5.85; 95%CI: -8.19 to -3.51; P<0.00001). Predictive characteristics of four factors were revealed in this Meta-analysis by assigning the patients to sufficient and insufficient groups according to postoperative visual field improvements, including preoperative visual field defect (WMD 10.09; 95%CI: 6.17 to 14.02; P<0.00001), patient age (WMD -12.32; 95%CI: -18.42 to -6.22; P<0.0001), symptom duration (WMD -5.04; 95%CI: -9.71 to -0.37; P=0.03), and preoperative peripapillary retinal nerve fiber layer (pRNFL) thickness (OR 0.1; 95% CI: 0.04 to 0.23; P<0.00001). CONCLUSION: Preoperative visual field defect, symptom duration, patient age, and preoperative pRNFL thickness are the dominant predictive factors of the postoperative recovery of the visual field for patients with pituitary adenoma.

18 Adaptive optics scanning laser ophthalmoscopy in fundus imaging, a review and update

Bing Zhang , Ni Li , Jie Kang , Yi He , Xiao-Ming Chen

2017, 10(11):1751-1758. DOI: 10.18240/ijo.2017.11.18

[Abstract](1912) [HTML](258) [PDF 722.40 K](810)

Abstract:
Adaptive optics scanning laser ophthalmoscopy (AO-SLO) has been a promising technique in funds imaging with growing popularity. This review firstly gives a brief history of adaptive optics (AO) and AO-SLO. Then it compares AO-SLO with conventional imaging methods (fundus fluorescein angiography, fundus autofluorescence, indocyanine green angiography and optical coherence tomography) and other AO techniques (adaptive optics flood-illumination ophthalmoscopy and adaptive optics optical coherence tomography). Furthermore, an update of current research situation in AO-SLO is made based on different fundus structures as photoreceptors (cones and rods), fundus vessels, retinal pigment epithelium layer, retinal nerve fiber layer, ganglion cell layer and lamina cribrosa. Finally, this review indicates possible research directions of AO-SLO in future.

19 Potential role of Müller cells in the pathogenesis of macropsia associated with epiretinal membrane: a hypothesis revisited

Ahmet Colakoglu , Solmaz Balci Akar

2017, 10(11):1759-1767. DOI: 10.18240/ijo.2017.11.19

[Abstract](1389) [HTML](246) [PDF 1.19 M](736)

Abstract:
Pathophysiological explanations for metamorphopsia associated with retinal pathologies generally focus on photoreceptor organization disruption. However, the retinal microarchitecture is complicated, and we hypothesize that other retinal cells may also be involved. Metamorphopsia has been widely studied in eyes with epiretinal membranes and we revisit the idea that Müller cell displacement causes retinal macropsia. A PubMed query and related article search for the macula ultrastructure under normal and pathological conditions revealed an enormous amount of information, particularly ultrahigh definition optical coherence tomography and other retinal imaging modality studies. Findings of these imaging studies support our hypothesis that Müller cells, and not cone photoreceptors, are primarily responsible for macropsia in eyes with epiretinal membranes. More specifically, we conclude that displacement of Müller cell endfeet, and not photoreceptor cones, is a more likely the explanation for retinal macropsia associated with epiretinal membranes.

20 A new interpretation and quantitative method for diplopia test: 304 cases of ocular motor nerve palsy for clinical test and verify

Ling-Yun Zhou , Tie-Juan Liu , Xue-Mei Li , Chang Su , Xiao-Jie Ji , Ming Zhao

2017, 10(11):1768-1770. DOI: 10.18240/ijo.2017.11.20

[Abstract](1311) [HTML](254) [PDF 724.13 K](689)

Abstract:
We introduce a new interpretation and quantitative method for computerized diplopia test. By comparing this new method to the Hess screen test, we validate its applicability among 304 patients with ocular motor nerve palsy. This new method shows great assistant value as the Hess screen test in making accurate diagnosis and quantitative evaluation the severity of diplopia. Furthermore, it is more convenient and suitable for daily clinical use.

21 The prevalence of uncorrected refractive error in urban, suburban, exurban and rural primary school children in Indonesian population

Indra Tri Mahayana , Sagung Gede Indrawati , Suhardjo Pawiroranu

2017, 10(11):1771-1776. DOI: 10.18240/ijo.2017.11.21

[Abstract](2045) [HTML](264) [PDF 321.02 K](787)

Abstract:
Uncorrected refractive error (URE) is a major health problem among school children. This study was aimed to determine the frequency and patterns of URE across 4 gradients of residential densities (urban, exurban, suburban and rural). This was a cross-sectional study of school children from 3 districts in Yogyakarta and 1 district near Yogyakarta, Indonesia. The information regarding age, sex, school and school grader were recorded. The Snellen’s chart was used to measure the visual acuity and to perform the subjective refraction. The district was then divided into urban, suburban, exurban and rural area based on their location and population. In total, 410 school children were included in the analyses (urban=79, exurban=73, suburban=160 and rural=98 school children). Urban school children revealed the worst visual acuity (P<0.001) and it was significant when compared with exurban and rural. The proportion of URE among urban, suburban, exurban and rural area were 10.1%, 12.3%, 3.8%, and 1%, respectively, and it was significant when compared to the proportion of ametropia and corrected refractive error across residential densities (P=0.003). The risk of URE development in urban, suburban, exurban, and rural were 2.218 (95%CI: 0.914-5.385), 3.019 (95%CI: 1.266-7.197), 0.502 (95%CI: 0.195-1.293), and 0.130 (95%CI:0.017-0.972), respectively. Urban school children showed the worst visual acuity. The school children in urban and suburban residential area had 2 and 3 times higher risk of developing the URE.

22 The use of choline in association with the Bangerter filters for the treatment of amblyopia

Lelio Sabetti , Francesco Masedu , Chiara Tresca , Federica Bianchi , Marco Valenti

2017, 10(11):1777-1778. DOI: 10.18240/ijo.2017.11.22

[Abstract](1247) [HTML](257) [PDF 264.92 K](675)

Abstract:
The study investigated the effects of choline combined with Bangerter filter in the treatment of amblyopia. All amblyopic subjects used a Bangerter filter on the corrective spectacle lens (1d over the left eye, 1d over the right eye). Choline was then administered orally to 39 patients once daily, five days per week for the entire study period. Subjects treated with the Bangerter filter showed a mean visual acuity of 0.27 logMAR; at 12mo of treatment, the mean visual acuity reached 0.09 logMAR. Patients treated with the Bangerter filter and citicoline showed a mean visual acuity of 0.35 logMAR; at 12mo of treatment, the mean visual acuity reached 0.01 logMAR. No significant changes in the angle of deviation were observed in both groups. Subjects in both forms of amblyopia therapies demonstrated an increase in visual acuity. However, these effects were markedly enhanced when coupled with the administration of choline. Findings suggest that the effects are particularly relevant in the more severe amblyopic cases.

23 Optical coherence tomography changes following vitrectomy for long standing premacular hemorrhage in Valsalva retinopathy

Vinod Kumar

2017, 10(11):1779-1782. DOI: 10.18240/ijo.2017.11.23

[Abstract](1547) [HTML](232) [PDF 2.83 M](672)

Abstract:

24 Acquired ptosis associated with oculomotor and contralateral facial nerve synkinesis: the first reported case

Mauro Tarallo , Magda Gharbiya , Maria Giuseppina Onesti , Andrea Conversi , Marco Toscani , Pasquale Fino , Nicolò Scuderi , Giuseppe Di Taranto

2017, 10(11):1783-1785. DOI: 10.18240/ijo.2017.11.24

[Abstract](1478) [HTML](248) [PDF 505.33 K](642)

Abstract:

25 Combined penetrating keratoplasty, pars plana vitrectomy and Ahmed glaucoma valve implant after open globe injury: a challenging approach

João Beato , António B. Melo , Pedro A. Faria , Luís Torrão , Fernando Falcão-Reis

2017, 10(11):1786-1788. DOI: 10.18240/ijo.2017.11.25

[Abstract](1446) [HTML](248) [PDF 555.37 K](763)

Abstract:

26 Comment on “The diurnal variation pattern of choroidal thickness in macular region of young healthy female individuals using spectral domain optical coherence tomography”

Salih Uzun , Emre Pehlivan , Mehmet Gulmez

2017, 10(11):1789-1790. DOI: 10.18240/ijo.2017.11.26

[Abstract](1089) [HTML](262) [PDF 216.01 K](875)

Abstract:

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Volume 10,Issue 11,2017 Table of Contents