Volume 10,Issue 12,2017 Table of Contents

1 Suppression of corneal neovascularization by curcumin via inhibition of Wnt/β-catenin pathway activation

Yong-Kang Zhang , Jing-Ming Li , Li Qin

2017, 10(12):1791-1797. DOI: 10.18240/ijo.2017.12.01

[Abstract](1597) [HTML](255) [PDF 2.17 M](724)

Abstract:
AIM: To investigate whether curcumin suppressed corneal neovascularization (CNV) formation via inhibiting activation of Wnt/β-catenin pathway. METHODS: Suture-induced CNV was established on Sprague-Dawley (SD) rats. Curcumin were daily administrated by subconjunctival injection. Phosphorylation of low-density lipoprotein receptor-related protein 6 (LRP6) and nuclear accumulation of β-catenin, two indicators of activated Wnt/β-catenin pathway, were determined by Western-blot analysis in subconfluent/proliferating human microvascular endothelial cells (HMEC) and neovascularized corneas. Wnt3a conditioned medium (WCM) were harvested from Wnt3a expressing cells. WCM-induced cell proliferation and endothelial tubular formation capacity was measured by MTT assay and Matrigel assay, respectively. RESULTS: Phosphorylation of LRP6 and nuclear accumulation of β-catenin was significantly increased in subconfluent/proliferating endothelial cells. Activation of Wnt/β-catenin pathway by WCM markedly promotes HMEC proliferation and tubular formation. Curcumin inhibited LRP6 phosphorylation and nuclear accumulation of β-catenin. In addition, curcumin attenuated WCM-induced HMEC proliferation and disrupted tubular structure of endothelial cells on Matrigel. Meanwhile curcumin suppressed suture-induced CNV and inhibited LRP6 phosphorylation as well as β-catenin accumulation in SD rats. CONCLUSION: Taken together, activation of Wnt/β-catenin pathway could be involved in endothelial proliferation during suture-induced CNV formation and curcumin attenuated CNV formation via inhibition of Wnt/β-catenin pathway activation.

Min Wu , De-Xuan Kuang , Ya-Qi Huang , Yu-Run Miao , Xiao-Cheng Liu , Jie-Jie Dai

2017, 10(12):1798-1804. DOI: 10.18240/ijo.2017.12.02

[Abstract](1733) [HTML](259) [PDF 786.42 K](827)

Abstract:
AIM: To determine the impact of age on the morphology of endothelial cells and central corneal thickness (CCT) in Chinese tree shrew. METHODS: One-hundred and twenty eyes of 60 healthy Chinese tree shrews were studied. Based on age, the tree shrews were divided into four groups. After general anesthesia, the images of endothelium were acquired using non-contact specular microscope Topcon 3000P. Eight parameters of corneal endothelial cells were measured by built-in software, including CCT, endothelial cell density (ECD), percent hexagonality (HG%), coefficient of variability (CV), size of minimal cell (Smin), size of maximal cell (Smax), average cells size (Savg) and size standard deviation (Ssd). Data were analyzed using STATA software. The differences of eight parameters among groups and correlations with age were analyzed. RESULTS: In all studied animals, the average CCT was 249.6±20.29 μm (202-301 μm), ECD was 3080.72± 460.76 cells/mm2 (1239.6-4047.6 cells/mm2) and CV was 29.10±7.60 (13.6-54.6). CV was significantly different among different groups (P<0.001). Strong correlation with age was found in ECD, Smax, Savg, Ssd and CV. CONCLUSION: Cornea of Chinese tree shrews had half CCT of human cornea and similar ECD, CV and size of corneal endothelial cells. Young adult tree shrews had higher ECD, HG% and low CV. ECD, Smax, Savg, Ssd and CV correlated with age significantly.

3 Involvement of Rho-associated coiled-coil kinase signaling inhibition in TGF-β1/Smad2, 3 signal transduction in vitro

Zhao-Hui Feng , Xiao-Hui Zhang , Jia-Qi Zhao , Jun-Ze Ma

2017, 10(12):1805-1811. DOI: 10.18240/ijo.2017.12.03

[Abstract](1532) [HTML](248) [PDF 939.27 K](668)

Abstract:
AIM: To research the effect of Y-27632, a selective Rho-associated coiled-coil kinase (ROCK) inhibitor, on TGF-β1/Smad2, 3 signal transduction in ocular Tenon’s capsule fibroblasts (OTFs). METHODS: Primary ocular Tenon’s capsule fibroblasts had been cultured in vitro. The effect of Y27632 on proliferation of OTF stimulated by lysophosphatidic acid (LPA) was evaluated by MTT colorimetric assay so as to sift out the proper concentrations range of Y-27632 for the next experiment. Real time-polymerase chain reactor (RT-PCR) was to analyze the changes of Smad2 and Smad3 genes of cells affected by Y-27632, though unaffected by transforming growth factor-beta1 (TGF-β1). Proteins of Smad2, Smad3, phosphorylated Smad2 (Ser245/250/255), and phosphorylated Smad3 (Ser423/425/203) were respectively quantified by Western blot after OTFs were successively incubated by TGF-β1 and Y-27632. Meanwhile, α-smooth muscular actin (α-SMA) protein was also quantified after the small intervening gene fragments of human Smad2 and Smad3 were designed, synthesized, and then transfected to OTFs. RESULTS: Y-27632 significantly inhibited OTFs proliferation stimulated by LPA. Also Y-27632 significantly suppressed the expressions of Smad2 mRNA, Smad2, 3 proteins expressions, Smad3 phosphorylation at the carboxylic terminals of Ser423/425/203 which had been radically promoted by TGF-β1. SiRNA-Smad2, 3 suppressed α-SMA expressions, but less effectively than Y-27632. CONCLUSION: The inhibition of ROCK signaling may be a potential therapeutic candidate for the treatment of the filtration channel fibrosis.

4 Pioglitazone ameliorates retinal ischemia/reperfusion injury via suppressing NLRP3 inflammasome activities

Yue-Lu Zhang , Ruo-Bing Wang , Wei-Yi Li , Fang-Zhou Xia , Lin Liu

2017, 10(12):1812-1818. DOI: 10.18240/ijo.2017.12.04

[Abstract](1667) [HTML](241) [PDF 3.04 M](666)

Abstract:
AIM: To explore the role of Pioglitazone (Pio) on a mouse model of retinal ischemia/reperfusion (I/R) injury and to elucidate the potential mechanism. METHODS: Retinal ischemia was induced in mice by increasing the intraocular pressure, and Pio was administered 4h though periocular injection before I/R. The number of cells in the ganglion cell layer (GCL) was counted 7d after retinal I/R injury. Glial fibrillary acidic protein (GFAP), nuclear factor-kappa B (NF-κB), p38, phosphorylated-p38, PPAR-γ, interleukin-1β (IL-1β), Toll-like receptor 4 (TLR4), NLRP3, cleaved caspase-1, caspase-1 were determined by real-time polymerase chain reaction and Western blotting. RESULTS: Pio promoted the survival of retinal cells in GCL following retinal I/R injury (P<0.05). Besides, retinal I/R injury stimulated the expression of GFAP and TLR4, which were partially reversed by Pio treatment (P<0.05). Retinal I/R injury-upregulated expression of NLRP3, cleaved caspase-1, IL-1β was attenuated after Pio treatment (P<0.05). Moreover, I/R injury induced activation of NF-κB and p38 were inhibited by Pio treatment (P<0.05). CONCLUSION: Pio promotes retinal ganglion cells survival by suppressing I/R-induced activation of TLR4/NLRP3 inflammasomes via inhibiting NF-κB and p38 phosphorylation.

5 Clinical and experimental study on angiopoietin-like protein 8 associated with proliferative diabetic retinopathy

Chang-Xia Dong , Cai-Ping Song , Chun-Ping Zhang , Mei Dong , Xiu-Rong Gong , He-Ying Gao , Hong Wang

2017, 10(12):1819-1823. DOI: 10.18240/ijo.2017.12.05

[Abstract](1426) [HTML](253) [PDF 578.76 K](654)

Abstract:
AIM: To confirm the role of angiopoietin-like protein 8 (Angptl 8) in proliferative diabetic retinopathy (PDR). METHODS: The sera and aqueous humor of 10 PDR patients and 10 non-diabetic retinopathy (NDR) patients (idiopathic macular hole patients) were collected and the expression of Angptl 8 was detected by enzyme linked immune-sorbent assay (ELISA). Experimental diabetes mice model was induced with streptozotocin. The expression of glycosylated hemoglobin and Angptl 8 in sera was detected. Recombinant Angptl 8 was re-infused into wild type (WT) diabetic mice and spatial frequency threshold and contrast sensitivity were measured. In vitro retinal pigment epithelium (RPE) were stimulated by recombinant Angptl 8 for 24h. MMT assay were used to detect cell proliferation. At the same time, qRT-PCR and Western blot was used to measure the expression of proliferation-related factors in PRE cells. RESULTS: The expression of Angptl 8 was markedly increased in the sera and aqueous humor of PDR patients (F=99.02, P<0.0001 in sera; t=10.42, P<0.0001 in aqueous). After successfully establishing the diabetic mice model, we found that glycosylated hemoglobin and Angptl 8 expression levels were increased. Re-infusion of recombinant Angptl 8 into WT diabetic mice could further decrease spatial frequency threshold and contrast sensitivity (P<0.01). In vitro, RPE cells stimulated by recombinant Angptl 8 could increase the relative absorbance of MMT assay (1.486±0.042 vs 1.000±0.104, P<0.05) and proliferating cell nuclear antigen (PCNA) expression (0.55±0.01 vs 0.29±0.03, P<0.05). The proliferative effect of Angptl 8 is mainly mediated by increasing the expression of proliferation-activating factors cyclin A1 (4.973±0.205 vs 2.720±0.197, P<0.05), cyclin F (5.690±0.219 vs 4.297±0.292, P<0.05) and E2F2 (2.297±0.102 vs 1.750±0.146, P<0.05), and reducing the expression of proliferation-inhibiting factors cdkn1 (2.370±0.074 vs 3.317±0.135, P<0.05) and cdkn2 (4.793±0.065 vs 5.387±0.149, P<0.05). CONCLUSION: The expression of Angptl 8 is increased in PDR, and the increased Angptl 8 can promote proliferation and increase proliferation-related factors.

6 Infliximab relieves blood retinal barrier breakdown through the p38 MAPK pathway in a diabetic rat model

Mao-Song Xie , Yong-Zheng Zheng , Li-Bin Huang , Guo-Xing Xu

2017, 10(12):1824-1829. DOI: 10.18240/ijo.2017.12.06

[Abstract](1403) [HTML](258) [PDF 731.16 K](655)

Abstract:
AIM: To clarify the mechanism of infliximab treatment in diabetic macular edema (DME) and to provide a new alternative therapy for DME. METHODS: Rats were randomly divided into the control group, the model group and the infliximab treatment group. A diabetic rat model was created. The concentration of TNF-α in the vitreous body was detected by ELISA. The expressions of B-Raf, p38, claudin-1 and occludin in the retina were detected by Western blot. The integrity of the blood retinal barrier (BRB) was measured using Evan’s blue as a tracer. RESULTS: After three months and six months of the diabetes model, the vitreous TNF-α level in the model group was higher than that of the control group. It was also higher in treated group than that of the control group but was lower than that of the model group. The differences among the three groups were statistically significant (at 3mo, F=857.098, P<0.001; 6mo, F=1261.897, P<0.001). The retina B-Raf and p38 levels in the model group were higher than that of the control group. They were also higher in treated group than that of the control group but were lower than that of the model group. The differences among the three groups were statistically significant (B-Raf at 3mo, F=106.596, P<0.001 and at 6mo, F=200.681, P<0.001; p38 at 3mo, F=41.662, P<0.001 and at 6mo, F=67.979, P<0.001). The retina claudin-1 and occludin levels in the model group were lower than that of the control group. They were also lower in treated group than that of the control group but were higher than that of the model group. The differences among three groups were statistically significant (claudin-1 at 3mo, F=139.088, P<0.001 and at 6mo, F=128.415, P<0.001; occludin at 3mo, F=92.733, P<0.001 and at 6mo, F=104.478, P<0.001). The retinal Evans blue leakage in the model group was higher than that of the control group. It was also higher in treated group than that of the control group but was lower than that of the model group. The differences among the three groups were statistically significant (at 3mo, F=447.946, P<0.001; at 6mo, F=1610.732, P<0.001). CONCLUSION: In a diabetic rat model, infliximab may relieve TNF-α induced BRB breakdown via the B-Raf and p38 signaling pathway.

7 Anterior lamellar recession for management of upper eyelid cicatricial entropion and associated eyelid abnormalities

Tamer I.Gawdat , Mahmoud A. Kamal , Ahmed S.Saif , Mostafa M. Diab

2017, 10(12):1830-1834. DOI: 10.18240/ijo.2017.12.07

[Abstract](1373) [HTML](255) [PDF 926.44 K](577)

Abstract:
AIM: To evaluate the functional and aesthetic outcomes of upper eyelid cicatricial entropion (UCE) correction using anterior lamellar recession (ALR) with addressing the associated conditions including dermatochalasis, brow ptosis, blepharoptosis, and lid retraction. METHODS: Chart review of patients with upper lid cicatricial entropion who had undergone ALR from 2013 to 2016 was reviewed. Success was defined as the lack of any lash in contact with the globe, no need for a second procedure, and acceptable cosmesis at the final follow up. RESULTS: Sixty eight patients (97 eyelids) were operated by ALR with simultaneous correction of associated lid problems in each case when necessary. The mean follow-up time was 17.8mo (range, 6.0-24.0mo). Concomitantly, levator tucking was performed in 19 eyelids (19.6%), upper lid retractor recession in 18 eyelids (18.6%), and internal browpexy in 31 eyelids (32.0%). In 95.8% of patients (95%CI: 0.85-0.96), satisfactory functional and cosmetic outcome was achieved with a single surgical procedure. CONCLUSION: Based on the principles of lamellar recession and concurrently addressing the associated lid problems, this approach is an effective and safe treatment of UCE.

8 Timing and approaches in congenital cataract surgery: a four-year, two-layer randomized controlled trial

Hao-Tian Lin , Er-Ping Long , Jing-Jing Chen , Zhen-Zhen Liu , Zhuo-Ling Lin , Qian-Zhong Cao , Xia-Yin Zhang , Xiao-Hang Wu , Qi-Wei Wang , Duo-Ru Lin , Xiao-Yan Li , Jin-Chao Liu , Li-Xia Luo , Bo Qu , Wei-Rong Chen , Yi-Zhi Liu

2017, 10(12):1835-1843. DOI: 10.18240/ijo.2017.12.08

[Abstract](1845) [HTML](247) [PDF 730.19 K](718)

Abstract:
AIM: To compare visual prognoses and postoperative adverse events of congenital cataract surgery performed at different times and using different surgical approaches. METHODS: In this prospective, randomized controlled trial, we recruited congenital cataract patients aged 3mo or younger before cataract surgery. Sixty-one eligible patients were randomly assigned to two groups according to surgical timing: a 3-month-old group and a 6-month-old group. Each eye underwent one of three randomly assigned surgical procedures, as follows: surgery A, lens aspiration (I/A); surgery B, lens aspiration with posterior continuous curvilinear capsulorhexis (I/A+PCCC); and surgery C, lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy (I/A+PCCC+A-Vit). The long-term best-corrected visual acuity (BCVA) and the incidence of complications in the different groups were compared and analyzed. RESULTS: A total of 57 participants (114 eyes) with a mean follow-up period of 48.7mo were included in the final analysis. The overall logMAR BCVA in the 6-month-old group was better than that in the 3-month-old group (0.81±0.28 vs 0.96±0.30; P=0.02). The overall logMAR BCVA scores in the surgery B group were lower than the scores in the A and C groups (A: 0.80±0.29, B: 1.02±0.28, and C: 0.84±0.28; P=0.007). A multivariate linear regression revealed no significant relationships between the incidence of complications and long-term BCVA. CONCLUSION: It might be safer and more beneficial for bilateral total congenital cataract patients to undergo surgery at 6mo of age than 3mo. Moreover, with rigorous follow-up and timely intervention, the postoperative complications in these patients are treatable and do not compromise visual outcomes.

9 Clinical outcomes of a new diffractive multifocal intraocular lens

Baha Toygar , Ozge Yabas Kiziloglu , Okan Toygar , Ali Murat Hacimustafaoglu

2017, 10(12):1844-1850. DOI: 10.18240/ijo.2017.12.09

[Abstract](1364) [HTML](243) [PDF 646.51 K](611)

Abstract:
AIM: To evaluate clinical outcomes after implantation of a new diffractive aspheric multifocal intraocular lens (IOL) with +3.00 addition power. METHODS: This is a retrospective, consecutive case series of cataract patients who underwent bilateral implantation of the Optiflex MO/HF D012 (Moss Vision Inc. Ltd, London, UK) multifocal IOL. Patients followed for 6mo were included in the study. Data on distance, intermediate and near visual acuity, refractive error [manifest spherical equivalent (MSE)], contrast sensitivity, adverse events, subjective symptoms, spectacle independence and patient satisfaction [visual function questionnaire (VFQ)-25 questionnaire] were retrieved from electronic medical records and analyzed. RESULTS: Forty eyes of 20 patients with a mean age of 66.7±8.5y (range: 53-82) were included in the study. Mean uncorrected distance, near and intermediate visual acuity remained stable through postoperative visits and was 0.19±0.19 logMAR, Jaeger 4 and Jaeger 3 respectively at the 6mo visit. At the end of postoperative 6mo, MSE was -0.14±0.42 diopters (D) and 98% of the eyes were within 1.00 D of target refraction. Postoperative low contrast (10%) visual acuity remained stable (P=0.54) through follow up visits with a mean of 0.35±0.17 logMAR at the 6mo visit. There were no reported adverse events. None of the patients reported subjective symptoms of halo or glare. Spectacle independence rate was 90%. Mean VFQ-25 questionnaire score was 93.5±6.12. CONCLUSION: The Optiflex MO/HF-DO12 IOL was safely implanted and successfully restored distance, intermediate and near visual acuity without impairing contrast sensitivity. High levels of spectacle independence were achieved at all distances including intermediate distance.

10 Outcomes of small gauge pars plicata vitrectomy for patients with persistent fetal vasculature: a report of 105 cases

Jing-Hua Liu , Hai Lu , Song-Feng Li , Yong-Hong Jiao , Nan Lin , Ning-Pu Liu

2017, 10(12):1851-1856. DOI: 10.18240/ijo.2017.12.10

[Abstract](1001) [HTML](237) [PDF 810.82 K](585)

Abstract:
AIM: To evaluate the surgical outcomes in eyes with persistent fetal vasculatures (PFV) managed by small gauge pars plicata vitrectomy. METHODS: Consecutive patients with PFV treated by small gauge pars plicata vitrectomy at Beijing Tongren Eye Center between January 2010 and January 2013 were retrospectively reviewed. RESULTS: A total of 118 eyes of 105 patients with PFV were included and undergone small gauge pars plicata vitrectomy, of which 84 (71.2%) eyes had lensectomy and 16 (13.6%) eyes had lens aspiration and immediate intraocular lens implantation. The percentage of sutured scleral incision of 23 gauge vitrectomy (71.7%, 33/46) was higher than that of the 25 gauge vitrectomy (18.1%, 13/72). At last follow-up, visual acuity remained stable in 34 eyes (28.8%) and improved in 84 eyes (71.2%). Age at surgery (less than 2y), anterior type of PFV, and immediate IOL implantation were associated with postoperative improved visual acuity. Sixty five (55.1%) eyes had retinal detachment preoperatively, among which 33 (50.8%, 33/65) eyes had retinal reattachment or partial retinal reattachment. CONCLUSION: The results suggest that cases with PFV have a potential for developing good visual acuity after small gauge pars plicata vitrectomy with favorable anatomic outcomes and acceptable rate of serious surgical complications.

11 A new strategy to interpret OCT posterior pole asymmetry analysis for glaucoma diagnosis

Yi Zhang , Ni Li , Jun Chen , Hong Wei , Shan-Ming Jiang , Xiao-Min Chen

2017, 10(12):1857-1863. DOI: 10.18240/ijo.2017.12.11

[Abstract](1307) [HTML](243) [PDF 1.69 M](652)

Abstract:
AIM: To detect early glaucoma by optical coherence tomography (OCT) posterior pole asymmetry analysis. METHODS: Totally 39 eyes from 39 healthy subjects, 40 eyes from 40 mild glaucoma patients, 33 eyes from 33 moderate glaucoma patients and 41 eyes from severe glaucoma patients were included in this study. All subjects underwent posterior pole asymmetry analysis (PPAA) of OCT and the posterior pole area was divided into three zones. Means, standard deviations and 95% confidence intervals of each zone asymmetry in control group were assessed. Retina thickness asymmetry (RTA) of different stage of glaucoma were compared for each zone, and receiver operating characteristic (ROC) curves were made to test the efficacy of strategies using different zones to discriminate glaucomatous eyes from the healthy ones. RESULTS: In a healthy population, RTA of the centre zone showed the minimal mean value (3.085 μm), standard deviation (1.756), and the narrowest 95% confidence interval (from 2.360 to 3.810 μm). It was only in the center zone that RTA exhibited significant difference between control and moderate glaucoma group (P<0.01), as well as control and severe glaucoma group (P<0.00001). The strategy utilized in the center zone had the strongest diagnostic capability (zone 3 AUROC=0.816, P=0.0016) in comparison to that of the periphery area (zone 1 AUROC=0.675, P=0.0016; zone 2 AUROC=0.623, P=0.0197), the whole posterior pole involved interpreting strategy showed inferior diagnostic power than the centre zone dependent strategy (z=2.851, P=0.0044). CONCLUSION: Utilizing the posterior pole centre zone to interpret OCT PPAA results are more effective than making use of the whole posterior pole map.

12 Negative effects of transthyretin in high myopic vitreous on diabetic retinopathy

Jun Shao , Yong Yao

2017, 10(12):1864-1869. DOI: 10.18240/ijo.2017.12.12

[Abstract](1146) [HTML](255) [PDF 592.86 K](659)

Abstract:
AIM: To analyze the relationship between vitreous transthyretin (TTR) levels, high myopia and diabetic retinopathy (DR). METHODS: We selected 6722 individuals from the southern Jiangsu Province for diabetes and ophthalmic examinations. The TTR concentration in the vitreous of 50 patients with high myopia and diabetes, 50 patients with only DR, and 20 healthy controls were determined by ELISA. Key factors in Tie2 pathway in DR development including vascular endothecial growth factor (VEGF), Tie2, Angpt1, Angpt2, vascular endothelial growth factor receptor (VEGFR) 1 and VEGFR2 were also detected by ELISA. RESULTS: The prevalence of DR in patients with diabetes and myopia [<6.00 diopter (D)], diabetes and high myopia (>6.00 D), and diabetes without myopia were 11.1%, 2.5%, and 60.0%, respectively. The vitreous TTR concentration of patients with diabetes and high myopia was approximately 6.5- and 4.2-times higher than those of patients with DR and healthy controls, respectively (P<0.05). Following the vitreous TTR concentration, the levels of VEGF, Tie2, Angpt1, Angpt2, VEGFR1 and VEGFR2 in vitreous of diabetes and high myopia patients, DR patients and healthy controls were detected as dramatically fluctuated. CONCLUSION: The results suggest that TTR can affect the vitreous contents of key factors in Tie2 pathway for neovascularization, and there should be a protective association between abundant TTR levels in the vitreous of highly myopic patients and a decreased risk of DR.

13 Subfoveal choroidal thickness and volume in severe internal carotid artery stenosis patients

Hui Wang , Yan-Ling Wang , Hong-Yang Li

2017, 10(12):1870-1876. DOI: 10.18240/ijo.2017.12.13

[Abstract](1600) [HTML](243) [PDF 866.03 K](654)

Abstract:
AIM: To demonstrate the differences of retinal and choroidal structure changes in internal carotid artery (ICA) patients of China by enhanced-depth imaging optical coherence tomography (EDI-OCT). METHODS: A retrospective review was conducted of 46 patients with a diagnosis of ICA stenosis greater than 65% on only one side (the opposite ICA Stenosis had less than 40% stenosis) from June 2015 through June 2016. All of the patients were combined with amaurosis fugax, but without any abnormality with other ocular examination. Thickness and volume of choroid and retina were manually measured by EDI-OCT. Differences were compared between ICA stenosis eyes and fellow eyes. RESULTS: There were no significant differences in the retinal thickness, macular retinal nerve fiber layer (mRNFL) thickness, inner thickness, or outer retinal thickness between the ICA Stenosis group and the control group (P=0.834, 0.187, 0.552, and 0.903, respectively). The mean central choroidal thickness of the ICA Stenosis group was significantly lower than that of the control group (239.70±23.76 µm vs 257.46±22.13 µm, P<0.001). The percentage of ICA stenosis was significantly associated with the central choroidal thickness, central retinal thickness, foveal center choroidal volume, and foveal center retinal volume (r=0.854, 0.678, 0.729, and 0.785, respectively; P<0.001). There were no significant differences in the retinal and choroidal volume values in the 4 inner and 4 outer sectors between the two groups. CONCLUSION: The choroidal thickness in severe ICA stenosis eyes is lower than in fellow eyes. The choroidal thinning may occur before the retinal changes in patients with ocular ischemic syndrome. Evaluations of choroidal thickness may be useful to choose the optimal therapeutic schedule for ICA patients.

14 The impact of macular surgery in different grades of epiretinal membrane

Cosar Batman , Mehmet Citirik

2017, 10(12):1877-1882. DOI: 10.18240/ijo.2017.12.14

[Abstract](1363) [HTML](249) [PDF 1.06 M](596)

Abstract:
AIM: To assess the impact of macular surgery on the functional and anatomic outcomes of the patients in different grades of epiretinal membrane (ERM). METHODS: Seventy-one eyes of 71 patients who underwent 23-gauge transconjunctival sutureless pars plana vitrectomy for primary isolated ERM were evaluated in this study. RESULTS: There were 38 females (53.5%) and 33 males (46.5%). The average age of the patients was 68.1y (range 42-89y). Mean follow up period was 14mo (range 6-26mo). The cases were divided into two subgroups of cellophane maculopathy (CM) and macular pucker (MP). An improvement was observed in the postoperative best-corrected visual acuity (BCVA), as well as a decrement in central foveal thickness (CFT) in both groups (both of these being statistically significant; P=0.001). In comparison between two groups, it was found that there was a significant improvement on BCVA and CFT in CM group than MP group (P=0.01). Furthermore, the postoperative fundus findings regarding RPE alterations and macular edema were significantly higher in MP group when compared to the CM group (P=0.01). CONCLUSION: ERM and internal limiting membrane peeling surgery can lead to a significant reduction of CFT and visual improvements in idiopathic ERM. A long-term ERM persistence will cause unrecoverable retinal damage and visual loss.

15 Optic nerve compression: the role of the lamina cribrosa and translaminar pressure

Mario R Romano , Gilda Cennamo , Maria Angelica Breve , Michela Piedepalumbo , Claudio Iovino , Nunzio Velotti , Giovanni Cennamo

2017, 10(12):1883-1888. DOI: 10.18240/ijo.2017.12.15

[Abstract](1054) [HTML](237) [PDF 647.78 K](592)

Abstract:
AIM: To describe the morphological changes of the lamina cribrosa (LC) in patients with optic nerve compression. METHODS: Cross-sectional study. Twenty eyes with optic nerve compression, affected by Graves' ophthalmopathy (GO) were compared with 18 refractive error-matched healthy eyes. The following examinations were performed: best-corrected visual acuity (BCVA), intraocular pressure, optic nerve echography, visual field, SD-OCT including the retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), and LC thickness and extent. RESULTS: A-scan revealed significant differences in the subarachnoid space (SAS) between the affected and control groups. LC thickness and LC area were 233 µm (SD 23) and 0.41 mm2 (SD 0.19), respectively. Average GCC thickness (P=0.0005), LC thickness (P=0.001), MD (P=0.001) and PSD (P=0.001) differed significantly between the two groups; whereas LC area (P=0.2) and average RFNL (P=0.1) did not. CONCLUSION: Optic nerve compression reduces the SAS thereby altering the morphology of LC thickness and causing GCC damage.

16 Prevalence and treatment patterns of ranibizumab and photodynamic therapy in a tertiary care setting in Malaysia

Nur Afiqah Mohamad , Vasudevan Ramachandran , Patimah Ismail , Hazlita Mohd Isa , Yoke Mun Chan , Nor Fariza Ngah , Norshakimah Md Bakri , Siew Mooi Ching , Fan Kee Hoo , Wan Aliaa Wan Sulaiman

2017, 10(12):1889-1897. DOI: 10.18240/ijo.2017.12.16

[Abstract](1177) [HTML](250) [PDF 471.06 K](645)

Abstract:
AIM: To describe the prevalence and changes in treatment patterns of ranibizumab and photodynamic therapy (PDT) among retinal disease patients who attended the Ophthalmology Clinic in the tertiary care Hospital Selayang from 2010 to 2014. METHODS: Study subjects were recruited retrospectively using the Electronic Medical Record (EMR) database software in Hospital Selayang. Demographic data, medical history, diagnostic procedure, treatments and diagnosis of patients were recorded. RESULTS: The five-year analysis included 821 patients with a mean age of 65.9±11.73y. Overall, there were a higher number of males (63.1%) and a higher number of Chinese (47.4%) patients. Among the 821 patients, 62.9% received ranibizumab injection followed by 19.2% PDT therapy and 17.9% had ranibizumab combined with PDT therapy. Age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) were the most common retinal eye diseases reported, recording prevalence of 25.0% and 45.6%, respectively. The trend in ranibizumab treatment was reported to increase while PDT showed a decrease in trend from year 2010 to 2014. In terms of treatment, following multiple logistic regression, AMD was associated with the subjects being more likely to have received ranibizumab monotherapy (P<0.001) while PCV was associated with more likely to have received PDT (P<0.001) and PDT combined with ranibizumab therapy (P<0.001). CONCLUSION: The tertiary care setting in Malaysia is consistent with management of patients from other countries whereby ranibizumab is the most common treatment given to patients with AMD, while PCV patients most commonly receive PDT and ranibizumab combined with PDT therapy.

17 Scientometric analysis of published papers in global ophthalmology in the past ten years

Zheng-Lu Yu , Xin-Yue Hu , Ying-Na Wang , Zheng Ma

2017, 10(12):1898-1901. DOI: 10.18240/ijo.2017.12.17

[Abstract](1425) [HTML](235) [PDF 506.30 K](588)

Abstract:
AIM: To investigate the published papers of ophthalmology in past ten years and explore the development of ophthalmology. RESULTS: The number of ophthalmology papers increased from 7450 to 9089 during 2007 to 2017. The average rate increased 2.2% annually. USA accounts for one thirds of the total and two thirds of the highly cited papers. In Asia, China, Japan and South Korea were in Top 10 by the number of ophthalmology papers. UK, Germany, Japan and Australia also had great impact in global ophthalmology. The hot spots included endothelial growth factor, optical coherence tomography and open-angle glaucoma. CONCLUSION: USA is in the leading position in global ophthalmology. Part of Asian countries play an important role in the development of ophthalmology, but the impact needs to be improved.

18 Diverse roles of macrophages in intraocular neovascular diseases: a review

Ye-Di Zhou , Shigeo Yoshida , Ying-Qian Peng , Yoshiyuki Kobayashi , Lu-Si Zhang , Luo-Sheng Tang

2017, 10(12):1902-1908. DOI: 10.18240/ijo.2017.12.18

[Abstract](1571) [HTML](242) [PDF 510.63 K](671)

Abstract:
Macrophages are involved in angiogenesis, and might also contribute to the pathogenesis of intraocular neovascular diseases. Recent studies indicated that macrophages exert different functions in the process of intraocular neovascularization, and the polarization of M1 and M2 phenotypes plays extremely essential roles in the diverse functions of macrophages. Moreover, a large number of cytokines released by macrophages not only participate in macrophage polarization, but also associate with retinal and choroidal neovascular diseases. Therefore, macrophage might be considered as a novel therapeutic target to the treatment of pathological neovascularization in the eye. This review mainly summarizes diverse roles of macrophages and discusses the possible mechanisms in retinal and choroidal neovascularization.

19 Smartphones, tele-ophthalmology, and VISION 2020

Mehrdad Mohammadpour , Zahra Heidari , Masoud Mirghorbani , Hassan Hashemi

2017, 10(12):1909-1918. DOI: 10.18240/ijo.2017.12.19

[Abstract](3107) [HTML](264) [PDF 568.32 K](852)

Abstract:
Telemedicine is an emerging field in recent medical achievements with rapid development. The “smartphone” availability has increased in both developed and developing countries even among people in rural and remotes areas. Tele-based services can be used for screening ophthalmic diseases and also monitoring patients with known diseases. Electronic ophthalmologic records of the patients including captured images by smartphones from anterior and posterior segments of the eye will be evaluated by ophthalmologists, and if patients require further evaluations, they will be referred to experts in the relevant field. Eye diseases such as cataract, glaucoma, age-related macular degeneration, diabetic retinopathy, and retinopathy of prematurity are the most common causes of blindness in many countries and beneficial use of teleophthalmology with smartphones will be a good way to achieve the aim of VISION 2020 all over the world. Numerous studies have shown that teleophthalmology is similar to the conventional eye care system in clinical outcomes and even provides more patient satisfaction as it saves time and cost. This review explains how teleophthalmology helps to improve patient outcomes through smartphones.

20 Trans-epithelial accelerated corneal cross-linking for keratoconus in children

Andrew Olivo-Payne , Juan Carlos Serna-Ojeda , Erick Hernandez-Bogantes , Alexandra Abdala-Figuerola , Lucero Pedro-Aguilar , Alejandro Lichtinger , Arturo Ramirez-Miranda , Alejandro Navas , Enrique O. Graue-Hernandez

2017, 10(12):1919-1921. DOI: 10.18240/ijo.2017.12.20

[Abstract](1153) [HTML](261) [PDF 439.71 K](591)

Abstract:
The aim of the study is to evaluate the safety and efficacy of trans-epithelial accelerated corneal cross-linking (TE-ACXL) in children with progressive keratoconus. Retrospective, case-series of 23 eyes of 14 children who underwent TE-ACXL. Evaluations were performed at baseline and 1, 3, 6, 12 and 18mo postoperatively. Mean follow-up time of 23.82±3.15mo and mean age was 13.7±1.4y (range 11 to 16y). Mean preoperative uncorrected distance visual acuity changed from 0.92±0.45 logMAR (20/160) to 0.71±0.40 logMAR (20/100) (P=0.001). Mean keratometry (Km) changed from 53.87± 6.03 to 53.00±5.81 (P=0.001). Pachymetry did not have significant changes at last follow-up (P=0.30). The mean preoperative sphere was -5.58±2.48 and -4.89±4.66 D (P=0.11) at last follow-up; refractive cylinder from -5.58±2.48 to -5.02±2.23 (P=0.046). In conclusion, tomographic and refractive stability are shown in over 91% of eyes with pediatric progressive keratoconus who underwent TE-ACXL.

21 Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage

Biljana Kuzmanović Elabjer , Mladen Bušić , Ana Bišćan Tvrdi , Daliborka Miletić , Damir Bosnar , Mirjana Bjeloš

2017, 10(12):1922-1924. DOI: 10.18240/ijo.2017.12.21

[Abstract](1377) [HTML](243) [PDF 378.26 K](591)

Abstract:
Cross-sectional study of 75 consecutive patients presenting with acute symptomatic posterior vitreous detachment (ASPVD) and vitreous hemorrhage was conducted at University Eye Clinic, University Hospital “Sveti Duh”, Zagreb, Croatia. To check ultrasound reliability in detecting retinal tears in patients with ASPVD, transpalpebral ultrasound of the eye and the orbit was performed followed by fundus examination initially and in 6wk period. In 13 (17%) patients membranous lesion with ultrasound characteristics of retinal tear was detected. Ophthalmoscopy confirmed the diagnosis in 8/13 patients. In 62/75 patients neither ultrasound nor clinical examination revealed retinal tear. Sensitivity of ultrasound examination was 100%, specificity 92%, positive predictive value 62% and negative predictive value 100%. Ultrasound proved to be a reliable and accurate method for detection of retinal tears in ASPVD. Given the high sensitivity and negative predictive value, negative result on B-scan ultrasound excludes the probability of the retinal tear with a high degree of certainty.

22 Paracentesis following intravitreal drug injections in maintaining physiologic ocular perfusion pressure

Austin Bach , Artur Filipowicz , Aaron S. Gold , Azeema Latiff , Timothy G. Murray

2017, 10(12):1925-1927. DOI: 10.18240/ijo.2017.12.22

[Abstract](1031) [HTML](250) [PDF 383.90 K](604)

Abstract:
A retrospective analysis was performed of patients who received a paracentesis immediately following an intravitreal injection of bevacizumab or triamcinolone acetonide. These patients were previously diagnosed as having glaucoma, ocular hypertension, or had responded previously with sustained elevated intraocular pressure. Of 1661 procedures were performed. Totally 219 (13%) of the injections were on phakic patients. A median (SD) of 210 μL (40 μL) of aqueous was removed during each paracentesis. There were no reported incidences of any complications. We propose performing a paracentesis immediately following intravitreal injections for patients at risk for ocular hypertension, glaucoma, and retinal vein or artery occlusion.

23 Comparison of surgical outcome of trabeculectomy and phacotrabeculectomy in Chinese glaucoma patients

Bonnie Nga Kwan Choy

2017, 10(12):1928-1930. DOI: 10.18240/ijo.2017.12.23

[Abstract](1150) [HTML](253) [PDF 312.18 K](612)

Abstract:
Our study retrospectively reviewed the surgical outcomes up to 3mo of 38 consecutive Chinese glaucoma patients who underwent trabeculectomy (n=18) or phacotrabeculectomy (n=20). Baseline age, visual acuity, and intraocular pressure were comparable. Intraocular pressure from post-operative 1d to 3mo were similar between 2 groups. Complete success was achieved in 65% of phacotrabeculectomy, and 66.7% of trabeculectomy cases; while failure occurred in 16.7% of phacotrabeculectomy, and 10% of trabeculectomy cases at 3mo. Phacotrabeculectomy group consistently showed better improvement in visual acuity. Diffuse blebs occurred in 65% of phacotrabeculectomy and 83% of trabeculectomy eyes; and flat blebs in 35% of phacotrabeculectomy, but none after trabeculectomy. There was more hypotony (5% vs 0) after phacotrabeculectomy. To conclude, phacotrabeculectomy and trabeculectomy demonstrated comparable intraocular pressure control up to 3mo post-operatively. However, phacotrabeculectomy patients had better visual acuity improvement. Nonetheless, more diffuse bleb and less hypotony were present following trabeculectomy.

24 A novel suturing technique for filtering glaucoma surgery: the accordion suture

Mehmet Baykara , Basak Can Ermerak , Huri Sabur , Selim Genc

2017, 10(12):1931-1934. DOI: 10.18240/ijo.2017.12.24

[Abstract](1353) [HTML](238) [PDF 1.61 M](627)

Abstract:
AIM: To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure (IOP). METHODS: Description of ‘the accordion suture’ technique for mitomycin C augmented trabeculectomy. In cases of postoperative high IOP, pulling the loop of the suture helps to lift up the scleral flap by an even pressure on both edges. By means of this technique, the scleral flap opens up in an ‘‘accordion’’ manner, thus preventing flap obstruction and providing adequate aqueous flow. RESULTS: Our study group consisted of 8 eyes of 8 patients with neovascular glaucoma. Mean age of the subjects was 67.42±8.21y and female/male ratio was 4/4. Mean preoperative IOP was 37±7.48 mm Hg. Mitomycin C augmented trabeculectomy was carried out on the subjects without any complications. The scleral flap closure is performed with three separate sutures; initially, our accordion suture through the center of the flap, and two releasable sutures on both corners. All the patients received removal of two side releasable sutures concomitant with pulling the accordion suture, without any complications. The average traction time was 3.5±0wk postoperatively. The mean postoperative IOP was 11.37±2.72 mm Hg. No suture related complications were observed. CONCLUSION: This technique can be the suture of choice for filtering glaucoma surgery in experienced hands by its easy learning curve for precisely indicated patients.

25 Corneal matrix repair therapy with the regenerating agent in neurotrophic persistent epithelial defects

Canan Asli Utine , Ceren Engin Durmaz , Nilufer Koçak

2017, 10(12):1935-1939. DOI: 10.18240/ijo.2017.12.25

[Abstract](1326) [HTML](249) [PDF 832.30 K](668)

Abstract:

26 Lyme Borrelia as the etiological factor in three cases of primary inflammatory choriocapillaropathies

Svetlana V. Jovanovic , Nenad T. Petrovic , Maja LJ. Zivkovic , Zorica G. Toncic , Tatjana S. Sarenac Vulovic

2017, 10(12):1940-1944. DOI: 10.18240/ijo.2017.12.26

[Abstract](1528) [HTML](245) [PDF 963.60 K](622)

Abstract:

27 Optical coherence tomography angiography in retinal cavernous hemangioma

Gilda Cennamo , Francesca Amoroso , Domenico Solari , Mariacristina Alfieri , Giuseppe de Crecchio

2017, 10(12):1945-1946. DOI: 10.18240/ijo.2017.12.27

[Abstract](1232) [HTML](228) [PDF 1.02 M](603)

Abstract:

28 Regarding successful use of 23G cutter for anterior vitrectomy and scleral-fixated intraocular lens implantation

Koushik Tripathy

2017, 10(12):1947-1948. DOI: 10.18240/ijo.2017.12.28

[Abstract](992) [HTML](245) [PDF 254.78 K](550)

Abstract:

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Volume 10,Issue 12,2017 Table of Contents