Volume 11,Issue 1,2018 Table of Contents

1 Experimental circumferential canaloplasty with a new Schlemm canal microcatheter

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

2018, 11(1):1-5. DOI: 10.18240/ijo.2018.01.01

[Abstract](1419) [HTML](228) [PDF 0.00 Byte](357)

Abstract:
AIM: To present a new, simple, inexpensive Schlemm canal microcatheter for circumferential canaloplasty in a rabbit model. METHODS: A rabbit glaucoma animal model was established by intravitreal injection of triamcinolone acetonide. Circumferential canaloplasty with a new Schlemm canal microcatheter (patent license number: 201220029850.0) was performed. The Schlemm canal microcatheter was composed of microcatheter wall and lumen. The wall was made of high refractive index plastic optical fiber that could be attached to an illuminant so that the whole lighted microcatheter was visible during circumferential canaloplasty. The lumen could be attached to an injector for injection of viscoelastic during catheterization. Rabbits were divided randomly into the control, model and treatment groups. Intraocular pressure (IOP) was measured with a Tono-pen tonometer pre-operation and 3, 7, 14, 21 and 28d post-operation. Ultrasound biomicroscopy was performed to visualize the Schlemm canal microcatheter in the Schlemm canal and the sclera pool. RESULTS: The Schlemm canal microcatheter could be used to perform circumferential canaloplasty in the rabbit glaucoma animal model. IOP was lower in the treatment group than that in the model group 3, 7, 14 and 28d after operation. There were no significant differences in IOP between the control group and treatment group. The differences among the three groups were statistically significant (3d: F=41.985, P<0.001; 7d: F=65.696, P<0.001; 14d: F=114.599, P<0.001; 28d: F=55.006, P<0.001). CONCLUSION: Circumferential canaloplasty is safe and effective in control of experimental glaucoma model in rabbits.

2 Preloaded and non-preloaded intraocular lens delivery system and characteristics: human and porcine eyes trial

Byunghoon Chung , Hun Lee , Moonjung Choi , Kyoung Yul Seo , Eung Kweon Kim , Tae-im Kim

2018, 11(1):6-11. DOI: 10.18240/ijo.2018.01.02

[Abstract](3211) [HTML](247) [PDF 700.07 K](802)

Abstract:
AIM: To compare characteristics of preloaded and non-preloaded intraocular lens (IOL) delivery systems during IOL delivery procedures. METHODS: Total 101 human eyes were included in this prospective observational case series. Delivery characteristics of 5 types of IOLs including iSert250 NC60 (NC60), EnVista MX60 (MX60), AcrySof IQ SN60WF (SN60WF), TECNIS ZCB00 (ZCB00), and TECNIS PCB00 (PCB00) were investigated. NC60 and PCB00 were injected via preloaded delivery systems and other IOLs were injected via non-preloaded systems. In the human trial, time taken from IOL loading to completion of implantation was measured in all eyes undergoing conventional cataract surgery. Using 4 excised porcine eyes, dynamics of ophthalmic viscosurgical device (OVD) between an IOL injector and a porcine eye was analyzed using fluorescein sodium-stained OVD. RESULTS: The average time for IOL implantation was 22.0s for NC60, 43.2s for MX60, 32.3s for SN60WF, 41.4s for ZCB00, and 14.6s for PCB00 respectively. The number of cases with IOL manipulation with a second instrument was 6 for MX60, 2 for ZCB00, 0 for SN60WF, NC60, and PCB00. Amount of OVD pushed into a porcine eye was smaller with a preloaded system than with non-preloaded systems. CONCLUSION: IOL delivery with preloaded systems is faster and more predictable. Moreover, a preloaded delivery system shows relatively less OVD pushed into a porcine eye than non-preloaded systems.

3 Hydrogen peroxide-induced apoptosis of human lens epithelial cells is inhibited by parthenolide

Xing-Chao Shentu , Xi-Yuan Ping , Ya-Lan Cheng , Xin Zhang , Ye-Lei Tang , Xia-Jing Tang

2018, 11(1):12-17. DOI: 10.18240/ijo.2018.01.03

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Abstract:
AIM: To explore the effect of parthenolide on hydrogen peroxide (H2O2)-induced apoptosis in human lens epithelial (HLE) cells. METHODS: The morphology and number of apoptotic HLE cells were assessed using light microscopy and flow cytometry. Cell viability was tested by MTS assay. In addition, the expression of related proteins was measured by Western blot assay. RESULTS: Apoptosis of HLE cells was induced by 200 μmol/L H2O2, and the viability of these cells was similar to the half maximal inhibitory concentration (IC50), as examined by MTS assay. In addition, cells were treated with either different concentrations (6.25, 12.5, 25 and 50 μmol/L) of parthenolide along with 200 μmol/L H2O2 or only 50 μmol/L parthenolide or 200 μmol/L H2O2 for 24h. Following treatment with higher concentrations of parthenolide (50 μmol/L), fewer HLE cells underwent H2O2-induced apoptosis, and cell viability was increased. Further, Western blot assay showed that the parthenolide treatment reduced the expression of caspase-3 and caspase-9, which are considered core apoptotic proteins, and decreased the levels of phosphorylated nuclear factor-κB (NF-κB), ERK1/2 [a member of the mitogen-activated protein kinase (MAPK) family], and Akt proteins in HLE cells. CONCLUSION: Parthenolide may suppress H2O2-induced apoptosis in HLE cells by interfering with NF-κB, MAPKs, and Akt signaling.

4 EDIL3 depletion suppress epithelial-mesenchymal transition of lens epithelial cells via transforming growth factor β pathway

Rui Zhang , You-Heng Wei , Chun-Yan Zhao , Hong-Yuan Song , Ni Shen , Xiao Cui , Xin Gao , Zhong-Tian Qi , Ming Zhong , Wei Shen

2018, 11(1):18-24. DOI: 10.18240/ijo.2018.01.04

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Abstract:
AIM: To study the effect of discoidin I-like domaincontaining protein 3 (EDIL3) depletion on the proliferation and epithelial-mesenchymal transition (EMT) in human lens epithelial cells (LECs). METHODS: RNA interference was used to inhibit the expression of EDIL3 in human LECs in vitro. The morphology of cells was observed using an inverted microscope. Cell proliferation was assessed using EdU kit. Cell migration was investigated using Transwell chamber and EMT of LECs was assessed using confocal microscope and Western blotting. The transforming growth factor β (TGFβ) pathway was investigated using Western blotting. RESULTS: The data showed that silencing EDIL3 expression changed LECs morphology and suppressed LECs proliferation (P<0.05) and migration (P<0.01). Furthermore, the result of Western blotting showed that EDIL3 depletion reduced the expression of α-smooth muscle actin (α-SMA) (P<0.001) and vimentin (P<0.01), while increased the expression of E-cadherin (P<0.001). EDIL3 depletion could suppress the phosphorylation of Smad2 (P<0.01) and Smad3 (P<0.01) and the activation of exracellular signal regulated kinase (ERK) (P<0.05). CONCLUSION: The findings indicate that EDIL3 might participate in the proliferation and EMT in LECs via TGFβ pathway and may be a potential therapeutic target for the treatment of posterior capsule opacification.

5 Safety threshold of intravitreal clonidine in rabbit’s eyes

Homayoun Nikkhah , Kiumars Heidari Garfami , Mozhgan Rezaei Kanavi , Ebrahim Mohammad Nashtaei , Saeed Karimi , Masoud Soheilian

2018, 11(1):25-30. DOI: 10.18240/ijo.2018.01.05

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Abstract:
AIM: To determine the safe dose of intravitreal clonidine (IVC), a potential drug for neuroprotection and angiogenesis inhibition in rabbits. METHODS: A total of 28 rabbits were divided into four groups. Three groups received IVC with concentrations of 15 (Group A), 25 (Group B), and 50 (Group C) μg/0.1 mL and the control group (Group D) received 0.1 mL balanced salt solution (BSS). To investigate IVC safety, electroretinography (ERG) was performed at baseline, then at 1, 4 and 8wk after injection. After last ERG, all rabbits were euthanized, their eyes were enucleated and subjected to routine histopathological evaluation, immunohistochemistry for glial fibrillary acidic protein (GFAP) and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) test. RESULTS: Based on ERG, histopathology, GFAP and TUNEL assay findings, 15 μg IVC was determined as the safe dose in rabbit eyes. While, the results of routine histopathology and TUNEL assay were unremarkable in all groups, toxic effects attributed to 25 and 50 μg IVC were demonstrated by ERG and GFAP tests. CONCLUSION: Totally 15 μg clonidine is determined as the safe dose for intravitreal injection in rabbits. Contribution of IVC in neuroprotection and inhibition of angiogenesis deserve more studies.

6 A novel mutation in PRPF31, causative of autosomal dominant retinitis pigmentosa, using the BGISEQ-500 sequencer

Yu Zheng , Hai-Lin Wang , Jian-Kang Li , Li Xu , Laurent Tellier , Xiao-Lin Li , Xiao-Yan Huang , Wei Li , Tong-Tong Niu , Huan-Ming Yang , Jian-Guo Zhang , Dong-Ning Liu

2018, 11(1):31-35. DOI: 10.18240/ijo.2018.01.06

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Abstract:
AIM: To study the genes responsible for retinitis pigmentosa. METHODS: A total of 15 Chinese families with retinitis pigmentosa, containing 94 sporadically afflicted cases, were recruited. The targeted sequences were captured using the Target_Eye_365_V3 chip and sequenced using the BGISEQ-500 sequencer, according to the manufacturer’s instructions. Data were aligned to UCSC Genome Browser build hg19, using the Burroughs Wheeler Aligner MEM algorithm. Local realignment was performed with the Genome Analysis Toolkit (GATK v.3.3.0) IndelRealigner, and variants were called with the Genome Analysis Toolkit Haplotypecaller, without any use of imputation. Variants were filtered against a panel derived from 1000 Genomes Project, 1000G_ASN, ESP6500, ExAC and dbSNP138. In all members of Family ONE and Family TWO with available DNA samples, the genetic variant was validated using Sanger sequencing. RESULTS: A novel, pathogenic variant of retinitis pigmentosa, c.357_358delAA (p.Ser119SerfsX5) was identified in PRPF31 in 2 of 15 autosomal-dominant retinitis pigmentosa (ADRP) families, as well as in one, sporadic case. Sanger sequencing was performed upon probands, as well as upon other family members. This novel, pathogenic genotype co-segregated with retinitis pigmentosa phenotype in these two families. CONCLUSION: ADRP is a subtype of retinitis pigmentosa, defined by its genotype, which accounts for 20%-40% of the retinitis pigmentosa patients. Our study thus expands the spectrum of PRPF31 mutations known to occur in ADRP, and provides further demonstration of the applicability of the BGISEQ500 sequencer for genomics research.

7 IgG4 and IgE co-positive group found in idiopathic orbital inflammatory disease

Peng-Xiang Zhao , Yao Mawulikplimi Adzavon , Jian-Min Ma , Lei Shang , Dan-Ying Chen , Fei Xie , Meng-Yu Liu , Xin Zhang , Bao-Bei Lyu , Ming-Zi Zhang , Lin-Qi Yang , Xue-Mei Ma

2018, 11(1):36-42. DOI: 10.18240/ijo.2018.01.07

[Abstract](1698) [HTML](242) [PDF 2.27 M](794)

Abstract:
AIM: To reveal the cytokines involved in idiopathic orbital inflammatory disease (IOID) and the relationship between Th17 cells, IgE and IOID pathogenesis. METHODS: Whole blood samples were processed immediately after collection and serological IgG4, IgG, and IgE antibodies were tested using ELISA. IOID and orbital cavernous hemangioma (CH) tissue samples underwent Bio-Plex multiplex cytokine detection. Hematoxylin-Eosin (HE) staining of all paraffin samples suggested the histological features of IOIDs, and expressions of IgG4 and IL-17A in affected tissues were detected by immunohistochemistry. RESULTS: Among 40 IOID plasma samples, 52.5% (21/40) were positive for IgG4 and 25% (10/40) were positive for IgE. Overlapped IgG4 or IgE positive samples accounted for 22.5% (9/40). Therefore, IOID samples were separated into three groups. The IgE+/IgG4+ group had a relevantly lower level of pro-inflammatory cytokine expression. IL-4 (Th2 cell related), IL-10 and TGF-β1 (Treg cell immunity related) were elevated in all three groups. Some of the Th17 cell related cytokines (i.e. IL-17A/F, IL-25, IL-23, and IL-33) displayed higher expression levels in the IgE-/IgG4- group compared to the other two groups. CONCLUSION: We discovered an IgG4-IgE co-positive group as well as Th17 cell immune involvement in IgG4-IgE co-negative subgtroup in IOID for the first time. The pathogenesis of IOID could differ from different subgroups according to the IgG4 and IgE detection. Therefore, we recommend that, Treatment stratagy should be made according to the clinical assessment of IgG4-IgE and Th17 profile detection.

8 A comparative study of risk factors for corneal infection in diabetic and non-diabetic patients

Bin Wang , Shuo Yang , Hua-Lei Zhai , Yang-Yang Zhang , Chun-Xia Cui , Jun-Yi Wang , Li-Xin Xie

2018, 11(1):43-47. DOI: 10.18240/ijo.2018.01.08

[Abstract](1484) [HTML](247) [PDF 301.44 K](742)

Abstract:
AIM: To compare the clinical characteristics of infectious keratopathy in type 2 diabetes mellitus (T2DM) and non-diabetes mellitus (NDM) and to investigate risk factors for infectious keratopathy in T2DM patients. METHODS: Totally 230 patients with T2DM and 168 with NDM diagnosed as infectious keratopathy were hospitalized at Qingdao Eye Hospital from 2001 to 2015. Data including sex, age, occupation, season, smoking and alcohol consumption habits, duration between onset and treatments, duration of hospitalization were collected. Initially identified indicators were analyzed with a multivariate logistic regression. Glycosylated hemoglobin A1c (HbA1c) in patients with T2DM was analyzed. The infectious keratopathies in the two groups were categorized and compared. RESULTS: The diabetic group consisted of 146 (63.5%) males and 84 (36.5%) females. The NDM group consisted of 111 (66.1%) males and 57 (33.9%) females. There was no signigicantly difference in sex distribution between the two groups (P>0.05). There were significant differences in age, occupation of patients, season of the onset of diseases, duration between onset and treatment, and durations of hospitalization between the two groups (P<0.05). In most of the patients in the diabetic group, the duration between onset and treatment was ≤3mo, and most was ≥3mo in the NDM group. Multivariate logistic regression analysis revealed that age and season were related to the development of corneal infection in the T2DM group (OR=1.709, 1.706). In the T2DM group, HbA1c was 9.09%±2.12%. There were statistically significant differences in the incidences of bacterial keratitis and herpes simplex keratitis in the two groups (P<0.05), but no significant statistical difference was found between fungal keratitis and amoebic keratitis (P>0.05). CONCLUSION: Advanced age and the summer and winter seasons are identified as risk factors for infectious keratopathy in T2DM patients, and T2DM patients are more prone to bacterial keratitis.

9 5-year follow-up of combined non-topography guided photorefractive keratectomy and corneal collagen cross linking for keratoconus

Abdulrahman Mohammed Al-Amri

2018, 11(1):48-52. DOI: 10.18240/ijo.2018.01.09

[Abstract](1966) [HTML](244) [PDF 447.05 K](700)

Abstract:
AIM: To evaluate the visual outcomes of simultaneous non-topography guided photorefractive keratectomy (PRK) and corneal collagen cross-linking (CXL) in eyes with keratoconus 5y after the procedure. METHODS: Prospective, interventional, non-randomized, and non-controlled case series design was used. Sixty eyes of 30 patients (16 males and 14 females; age: 21-41y) with mild, non-progressive (stages 1-2) keratoconus were enrolled. Refraction, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) , flat and steep keratometry readings, and adverse events were evaluated preoperatively and postoperatively. Data were collected preoperatively and postoperatively at 3mo, 1, 2, 3, 4, and 5y follow-up visits after combined non-topography-guided PRK with CXL was performed. All patients had at least 5y of follow-up. RESULTS: All study parameters showed a statistically significant improvement at 5y over baseline values. The mean follow-up time was 68.20±4.71mo (range: 60-106mo). Patients showed a significant improvement in UDVA from 1.24±0.79 logMAR prior to combined non-TG-PRK+CXL to 0.06±0.15 logMAR postoperatively at the time of their last follow-up visit. CDVA significantly increased from 0.06±0.19 logMAR preoperatively to 0.03±0.12 logMAR postoperatively. A significant decrease in the mean spherical equivalent (SE) refraction was observed from -2.28±1.8 to -0.79±0.93 diopters (D) (P<0.05), and the manifest sphere decreased from -1.62±1.23 to -0.27±0.21 D (P=0.001). The manifest cylinder significantly decreased from -1.73±0.86 to -0.29±0.34 D postoperatively (P=0.001). The mean steep keratometry was 45.13±1.32 vs 47.28±2.12 D preoperatively (P<0.05), and the preoperative mean steepest keratometry (Kmax) 48.6±3.1 was reduced significantly to 46.8±2.9 postoperatively (P<0.05). CONCLUSION: Combined non-TG-PRK with 15min CXL is an effective and safe option for correcting mild refractive error and improving visual acuity in patients with mild stable keratoconus.

10 Descemet stripping automated endothelial keratoplasty in phakic eyes: incision modification reducing cataract formation

Jacqueline Beltz , Silvana Madi , Yoav Nahum , Paolo Santorum , Massimo Busin

2018, 11(1):53-57. DOI: 10.18240/ijo.2018.01.10

[Abstract](1608) [HTML](239) [PDF 459.48 K](700)

Abstract:
AIM: To evaluate the efficacy of a technical modification to reduce the incidence of traumatic cataract induced by Descemet stripping automated endothelial keratoplasty (DSAEK) performed in phakic eyes. METHODS: A retrospective cohort study. The records of all patients with a clear crystalline lens and endothelial failure that underwent modified DSAEK at our insitution were reviewed. In this modification, in order to avoid inadvertent touch of the insertion forceps against the exposed crystalline lens while passing across the anterior chamber, the incision sites were shifted from the standard 9 and 3 o’clock positions, superiorly to the 10 and 2 o’clock position respectively. Formation of typically traumatic, anterior subcapsular cataract in these patients was compared to that observed in a cohort including all the patients with a clear crystalline lens and endothelial failure that underwent conventional DSAEK at our institution. RESULTS: The study group included 49 eyes following modified DSAEK and the control group included 35 eyes following DSAEK with conventional incision sites. Anterior subcapsular cataract occurring 4mo or less postoperatively was identified in 2 of 49 (4%) eyes in the study group and 7 of 35 (20%) eyes in the control group. The rates of traumatic cataract were significantly higher in the control group in comparison to the study group (P=0.03, RR=4.9, 95%CI 1.08-22.1). CONCLUSION: Traumatic cataract formation following phakic DSAEK may be avoided with a simple modification to the position of the incision sites.

11 Effect of infusion pressure during cataract surgery on ganglion cells measured using isolated-check visual evoked potential

Tong Ding , Dan-Na Shi , Xiang Fan , Mi-Yun Zheng , Wei Wang , Wei-Qiang Qiu

2018, 11(1):58-65. DOI: 10.18240/ijo.2018.01.11

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Abstract:
AIM: To detect the relationship between infusion pressure and postoperative ganglion cells function. METHODS: This prospective observational cohort study included sixty-one eyes that underwent uncomplicated cataract surgery. Patients were divided into two groups according to infusion time (IT) recorded using surgery equipment [Group A: IT>ITmean (27 eyes); Group B: IT

12 Comparison of long-term results of trabeculectomy to treat pseudoexfoliative glaucoma and primary open angle glaucoma

Vuslat Pelitli Gürlü , Hande Güçlü , Altan Özal , Ömer Benian , Levent Alimgil

2018, 11(1):66-70. DOI: 10.18240/ijo.2018.01.12

[Abstract](1297) [HTML](241) [PDF 804.91 K](677)

Abstract:
AIM: To compare the long term outcome of trabeculectomy in patients with pseudoexfoliative glaucoma (PEG) and primary open angle glaucoma (POAG) in terms of surgical success. METHODS: The success of the trabeculectomy was evaluated by three criteria. Criterion A: intraocular pressure (IOP) ≤21 mm Hg and decrease in IOP ≥20%; Criterion B: IOP ≤18 mm Hg and decrease in IOP ≥30%; Criterion C: IOP ≤15 mm Hg and decrease in IOP ≥50%. Patients that met these criteria without medical treatment were considered to be completely successful, while those that met these criteria with medical treatment were considered partially successful. Significance levels of differences between the POAG and PEG groups in the Kaplan-Meier survival curves were calculated with the log-rank test. RESULTS: Sixty-four eyes from 64 patients with PEG and 51 eyes from 51 patients with POAG were evaluated. No significant differences were detected between the PEG and POAG groups according to full or partial success relative to each of the three criteria (A: P=0.73, 0.32; B: P=0.73, 0.31; C:P=0.90, 0.27). CONCLUSION: There is no difference in the long-term success of trabeculectomy between PEG and POAG patients whose clinical characteristics are otherwise the same.

13 Efficacy of selective laser trabeculoplasty following incisional glaucoma surgery

Robert Allan Sharpe , Leah L Kammerdiener , David B. Williams , Sudeep K. Das , Matthew J. Nutaitis

2018, 11(1):71-76. DOI: 10.18240/ijo.2018.01.13

[Abstract](2525) [HTML](250) [PDF 620.53 K](643)

Abstract:
AIM: To evaluate the efficacy of selective laser trabeculoplasty (SLT) in glaucomatous eyes with previous incisional glaucoma surgery. METHODS: A retrospective cohort of eyes that underwent SLT at a single institution from 2013-2015 were followed for 1y. Reduction in intraocular pressure (IOP) following SLT was evaluated in eyes with prior trabeculectomy with ExPress mini shunt (Alcon, Ft Worth, TX, USA), Ahmed valve (New World Medical, Cucamonga, CA, USA), or combined phacoemulsification-trabeculectomy. A control group was included with eyes without prior surgery that underwent SLT. Success was defined as >20% drop in IOP from pre-SLT baseline. RESULTS: One-hundred and six eyes were included with 53 in both the prior glaucoma surgery (PGS) and no prior glaucoma surgery (NPGS) groups. Mean pre-SLT IOP was 19.2±4.3 and 20.6±6.0 mm Hg for PGS and NPGS groups, respectively (P=0.17). Both groups produced statistically significant IOP reductions at 1 and 6mo (P<0.04). At 6mo, mean IOP reduction reached 7.3% and 10.8% for the PGS and NPGS groups, respectively (P=0.42). Overall, 27.9% and 31.7% of eyes in PGS and NPGS groups met success criteria at 1y (P=0.70). In the PGS group, eyes with baseline IOP ≥21 mm Hg had IOP reductions of 18.1% (P<0.001), 16.7% (P<0.01), and 8.4% (P=0.31) compared to eyes with baseline IOP <21 mm Hg who had IOP reductions of 2.3% (P=0.39), 3.4% (P=0.19), and 1.1% (P=0.72) at 1, 6mo, and 1y, respectively. CONCLUSION: SLT is efficacious in eyes with prior incisional glaucoma surgery and results in similar IOP reductions compared to eyes without PGS. A larger IOP reduction is observed following SLT in eyes with higher pre-SLT IOP.

14 Intravitreal dexamethasone implants for diabetic macular edema

Alicia Pareja-Ríos , Paloma Ruiz-de la Fuente-Rodríguez , Sergio Bonaque-González , Maribel López-Gálvez , Virginia Lozano-López , Pedro Romero-Aroca

2018, 11(1):77-82. DOI: 10.18240/ijo.2018.01.14

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Abstract:
AIM: To evaluate the safety and efficacy of a dexamethasone (DEX) intravitreal implant for diabetic macular edema (DME). METHODS: Totally 113 eyes of 84 patients were divided in three subgroups: naive patients (n=11), pseudophakic patients (n=72) and phakic patients (n=30). Inclusive criterion comprised adult diabetic patients with central fovea thickening and impaired visual acuity resulting from DME for whom previous standard treatments showed no improvement in both central macular thickness (CMT) and best corrected visual acuity (BCVA) after at least 3mo of treatment. Outcome data were obtained from patient visits at baseline and at months 1, 3, 5, 9 and 12 after the first DEX implant injection. At each of these visits, patients underwent measurement of BCVA, a complete eye examination and measurement of CMT and macular volume (MV) carried out with optical coherence tomography (OCT) images. RESULTS: Seventy-three eyes (64.5%) received a single implant, 30 (26.5%) received two implants and 10 (9%) received three implants. At baseline, average in BCVA, CMT and MV were 43.5±20.8, 462.8±145 and 12.6±2.5 respectively. These values improved significantly at 1mo (BCVA: 47.2±19.5, CMT: 339.6±120, MV: 11.11±1.4) and 3mo (BCVA: 53.2±18.1, CMT: 353.8±141, MV: 11.3±1.3) (P≤0.05). At 5mo (BCVA: 50.9±19.8, CMT: 425±150, MV: 12.27±2.3), 9mo (BCVA: 48.4±17.6, CMT: 445.5±170, MV: 12.5±2.3) and 12mo (BCVA: 47.7±18.8, CMT: 413.2±149, MV: 12.03±2.5), improvements in the three parameters were no longer statistically significant and decreased progressively but did not reach baseline values. There were no clinical differences between subgroups. Ocular complications were minimal. CONCLUSION: Patients with DEX implants show maximum efficacy at 3mo which then declined progressively, but is still better than baseline values at the end of follow-up.

15 Final anatomic and visual outcomes appear independent of duration of silicone oil intraocular tamponade in complex retinal detachment surgery

Maedbh Rhatigan , Elizabeth McElnea , Patrick Murtagh , Kirk Stephenson , Elaine Harris , Paul Connell , David Keegan

2018, 11(1):83-88. DOI: 10.18240/ijo.2018.01.15

[Abstract](1949) [HTML](243) [PDF 681.00 K](626)

Abstract:
AIM: To report anatomic and visual outcomes following silicone oil removal in a cohort of patients with complex retinal detachment, to determine association between duration of tamponade and outcomes and to compare patients with oil removed and those with oil in situ in terms of demographic, surgical and visual factors. METHODS: We reported a four years retrospective case series of 143 patients with complex retinal detachments who underwent intraocular silicone oil tamponade. Analysis between anatomic and visual outcomes, baseline demographics, duration of tamponade and number of surgical procedures were carried out using Fisher’s exact test and unpaired two-tailed t-test. RESULTS: One hundred and six patients (76.2%) had undergone silicone oil removal at the time of review with 96 patients (90.6%) showing retinal reattachment following oil removal. Duration of tamponade was not associated with final reattachment rate or with a deterioration in best corrected visual acuity (BCVA). Patients with oil removed had a significantly better baseline and final BCVA compared to those under oil tamponade (P=0.0001, <0.0001 respectively). CONCLUSION: Anatomic and visual outcomes in this cohort are in keeping with those reported in the literature. Favorable outcomes were seen with oil removal but duration of oil tamponade does not affect final attachment rate with modern surgical techniques and should be managed on a case by case basis.

16 Retinal ganglion cell-inner plexiform and nerve fiber layers in neuromyelitis optica

Sai-Jing Hu , Pei-Rong Lu

2018, 11(1):89-93. DOI: 10.18240/ijo.2018.01.16

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Abstract:
AIM: To determine the thickness of the retinal ganglion cell-inner plexiform layer (GCIPL) and the retinal nerve fiber layer (RNFL) in patients with neuromyelitis optica (NMO). METHODS: We conducted a cross-sectional study that included 30 NMO patients with a total of 60 eyes. Based on the presence or absence of optic neuritis (ON), subjects were divided into either the NMO-ON group (30 eyes) or the NMO-ON contra group (10 eyes). A detailed ophthalmologic examination was performed for each group; subsequently, the GCIPL and the RNFL were measured using high-definition optical coherence tomography (OCT). RESULTS: In the NMO-ON group, the mean GCIPL thickness was 69.28±21.12 μm, the minimum GCIPL thickness was 66.02±10.02 μm, and the RNFL thickness were 109.33±11.23, 110.47±3.10, 64.92±12.71 and 71.21±50.22 μm in the superior, inferior, temporal and nasal quadrants, respectively. In the NMO-ON contra group, the mean GCIPL thickness was 85.12±17.09 μm, the minimum GCIPL thickness was 25.39±25.1 μm, and the RNFL thicknesses were 148.33±23.22, 126.36±23.45, 82.21±22.30 and 83.36±31.28 μm in the superior, inferior, temporal and nasal quadrants, respectively. In the control group, the mean GCIPL thickness was 86.98±22.37 μm, the minimum GCIPL thickness was 85.28±10.75 μm, and the RNFL thicknesses were 150.22±22.73, 154.79±60.23, 82.33±7.01 and 85.62±13.81 μm in the superior, inferior, temporal and nasal quadrants, respectively. The GCIPL and RNFL were thinner in the NMO-ON contra group than in the control group (P<0.05); additionally, the RNFL was thinner in the inferior quadrant in the NMO-ON group than in the control group (P<0.05). Significant correlations were observed between the GCIPL and RNFL thickness measurements as well as between thickness measurements and the two visual field parameters of mean deviation (MD) and corrected pattern standard deviation (PSD) in the NMO-ON group (P<0.05). CONCLUSION: The thickness of the GCIPL and RNFL, as measured using OCT, may indicate optic nerve damage in patients with NMO.

17 Effect of body position on the pathogenesis of asymmetric primary open angle glaucoma

Jing Tang , Ni Li , Ying-Ping Deng , Le-Mei Qiu , Xiao-Ming Chen

2018, 11(1):94-100. DOI: 10.18240/ijo.2018.01.17

[Abstract](1989) [HTML](254) [PDF 877.45 K](661)

Abstract:
AIM: To explore the pathogenesis of asymmetric primary open angle glaucoma (POAG) in both eyes by comparing the intraocular pressure (IOP) of patients who sleep in different positions and to investigate the relationship between IOP variations and sleep positions. METHODS: One hundred and thirty-one patients with asymmetric POAG and forty-six healthy volunteers were enrolled. All participants completed a questionnaire that provided information about their sleep laterality. The cup disc ratio (C/D) and visual field defect established binocular asymmetry. The IOP of both eyes was measured using iCare parameters after the patients were asked to change body position. The “worse” and “better” eyes were identified according to the diagnosis, whereas the “dependent” and “independent” eyes were defined according to the lateral position. RESULTS: No significant difference in sleep laterality was observed between healthy people and patients with POAG (F=3.195, P=0.362). Among the enrolled patients, the IOP of the dependent eye was always greater than that of the independent eye in the lateral position (P<0.05). In the patients with binocular asymmetric POAG, the questionnaire clearly showed that 85.7% of left side preferences were found their left eyes to be the worse eyes and the right eyes of 71.4% patients with a right side preference were the more serious. When the asymmetric C/D ratio was greater than or equal to 0.2, the worse eye of patients with POAG and a preferred sleeping position was the dependent eye (χ2=16.762, P=0.001). CONCLUSION: A higher IOP was measured in the dependent eye in the lateral position. The long-term tendency to choose a lateral sleeping position might lead the dependent eye to manifest more severe symptoms than the independent eye. Thus, the lateral sleeping position might be one cause of asymmetric POAG.

18 Roles of the eye care workforce for task sharing in management of diabetic retinopathy in Cambodia

Mufarriq Shah , Gail M. Ormsby , Ayesha Noor , Rahul Chakrabarti , Manfred Mörchen , Fakir M Amirul Islam , C Alex Harper , Jill E Keeffe

2018, 11(1):101-107. DOI: 10.18240/ijo.2018.01.18

[Abstract](2584) [HTML](247) [PDF 365.01 K](688)

Abstract:
AIM: To identify the current roles of eye and health care workers in eye care delivery and investigate their potential roles in screening and detection for management of diabetic retinopathy (DR) through task sharing. METHODS: Purposive sampling of 24 participants including health administrators, members from non-government organizations and all available eye care workers in Takeo province were recruited. This cross sectional mixed method study comprised a survey and in-depth interviews. Data were collected from medical records at Caritas Takeo Eye Hospital (CTEH) and Kiri Vong District Referral Hospital Vision Centre, and a survey and interviews with participants were done to explore the potential roles for task sharing in DR management. Qualitative data were transcribed into a text program and then entered into N-Vivo (version 10) software for data management and analysis. RESULTS: From 2009 to 2012, a total of 105 178 patients were examined and 14 030 eye surgeries were performed in CTEH by three ophthalmologists supported by ophthalmic nurses in operating and eye examination for patients. Between January 2011 and September 2012, 151 patients (72 males) with retinal pathology including 125 (83%) with DR visited CTEH. In addition 170 patients with diabetes were referred to CTEH for eye examinations from Mo Po Tsyo screening programs for people with diabetes. Factors favouring task sharing included high demand for eye care services and scarcity of ophthalmologists. CONCLUSION: Task sharing and team work for eye care services is functional. Participants favor the potential role of ophthalmic nurses in screening for DR through task sharing.

19 The Beijing Desheng Diabetic Eye Study: rationale, design, methodology and baseline data

Yun-Yun Li , Xiu-Fen Yang , Hong Gu , Xi-Pu Liu , Torkel Snellingen , Ning-Pu Liu

2018, 11(1):108-116. DOI: 10.18240/ijo.2018.01.19

[Abstract](2017) [HTML](236) [PDF 559.08 K](722)

Abstract:
AIM: To present the rationale, design, methodology, and the baseline data of the Beijing Desheng Diabetic Eye Study (BDDES), and to determine the prevalence of diabetic retinopathy (DR) and possible risk factors in patients with type 2 diabetes mellitus (T2DM) in an urban community of Beijing, China. METHODS: Community-based prospective cohort study of persons diagnosed with T2DM aged 30y or older. The main variables of interest are the presence and progression of DR as determined by the standardized ETDRS grading of seven fields fundus photographs. The presence and severity of DR were analyzed for possible correlations to non-genetic and genetic dispositions. RESULTS: A total of 1438 participants with data available for analysis, the prevalence of any DR was 35.4%. The prevalence of mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy was 27.7%, 2.6%, 0.5% and 4.5%, respectively. By multiple logistic regression analysis, risk factors for the presence of any DR included male (P=0.031), lower income level (P=0.011), lower education background (P=0.022), longer duration of diabetes (P=0.001), younger age at diabetic onset (P=0.001), higher systolic blood pressure (P=0.007), higher glycosylated hemoglobin A1c levels (P=0.001), high albuminuria (P=0.03), and use of insulin (P<0.001). For vision-threatening DR, four factors were significant: younger age at diabetic onset (P<0.001), higher systolic blood pressure (P=0.042), high albuminuria (P<0.001), and use of insulin (P<0.001). CONCLUSION: The BDDES is the first large-scale ongoing cohort study of a Chinese urban population of persons with type 2 diabetes. Using standardized grading system comparable to large cohort studies from western populations, our baseline data shows that the prevalence of DR and major risk factors in this Chinese ethnic population are comparable to that found in the western population studies.

20 Genes and genetics in eye diseases: a genomic medicine approach for investigating hereditary and inflammatory ocular disorders

Mahavir Singh , Suresh C Tyagi

2018, 11(1):117-134. DOI: 10.18240/ijo.2018.01.20

[Abstract](2828) [HTML](269) [PDF 663.89 K](919)

Abstract:
Past 25y have witnessed an exponential increase in knowledge and understanding of ocular diseases and their respective genetic underpinnings. As a result, scientists have mapped many genes and their variants that can influence vision and health of our eyes. Based on these findings, it is becoming clear that an early diagnosis employing genetic testing can help evaluate patients’ conditions for instituting treatment plan(s) and follow-up care to avoid vision complications later. For example, knowing family history becomes crucial for inherited eye diseases as it can benefit members in family who may have similar eye diseases or predispositions. Therefore, gathering information from an elaborate examination along with complete assessment of past medical illness by ophthalmologists followed by consultation with geneticists can help create a roadmap for making diagnosis and treatment precise and beneficial. In this review, we present an update on ocular genomic medicine that we believe has tremendous potential towards unraveling genetic implications in ocular diseases and patients’ susceptibilities. We also discuss translational aspects of genetic ophthalmology and genome engineering that may help advance molecular diagnostics and therapeutics.

21 A feasibility study of using biodegradable magnesium alloy in glaucoma drainage device

Xiang-Ji Li , Lin Xie , Fu-Sheng Pan , Yong Wang , Hong Liu , Yu-Rong Tang , Cindy ML Hutnik

2018, 11(1):135-142. DOI: 10.18240/ijo.2018.01.21

[Abstract](2067) [HTML](257) [PDF 512.60 K](743)

Abstract:
Technological advances in glaucoma have challenged the traditional treatment paradigm. Historically incisional surgery has been used in cases of advanced disease and/or uncontrolled intraocular pressures resistant to medical or laser interventions. More recently, perhaps due to advancements in imaging, surgery has been suggested to be beneficial earlier in the treatment paradigm. Despite these trends, surgical manipulation of the tissues and unpredictability of wound healing continue to result in surgical failure. Magnesium is an essential element for human body and plays a critically important role in maintaining the functional and structural integrity of several tissues, including the eye. Due to several of its advantageous properties such as non-toxicity, biodegradability, and high biological compatibility, magnesium alloy has attracted great attention as a novel biomaterial. Biodegradable cardiovascular stents made of magnesium alloy have already been introduced into clinical practice. The purpose of this review is to determine if bioabsorbable magnesium alloys can be utilized as a promising candidate for the development of a new generation of glaucoma surgical assistive devices.

22 The role of microglia in the progression of glaucomatous neurodegeneration- a review

Hui-Lan Zeng , Jing-Ming Shi

2018, 11(1):143-149. DOI: 10.18240/ijo.2018.01.22

[Abstract](2395) [HTML](263) [PDF 483.52 K](758)

Abstract:
Glaucoma is a serious leading cause of irreversible blindness worldwide. Reducing intraocular pressure (IOP) does not always stop glaucomatous neurodegeneration and the optic nerve may continue to be damaged in the normal IOP. Microglial activity has been recognized to play essential roles in pathogenesis of the central nervous system (CNS) as well as retinal ganglion cell (RGC) survival. The relationship between the neurodegeneration and the microglia cells in glaucoma is very complicated and still remains unclear. In the present review, we summarize the recent studies of mechanisms of microglia in glaucoma neurodegeneration, which might provide new ways to treat glaucoma.

23 Application of stem cell-derived retinal pigmented epithelium in retinal degenerative diseases: present and future

Mingyue Luo , Youxin Chen

2018, 11(1):150-159. DOI: 10.18240/ijo.2018.01.23

[Abstract](1869) [HTML](238) [PDF 322.50 K](710)

Abstract:
As a constituent of blood-retinal barrier and retinal outer segment (ROS) scavenger, retinal pigmented epithelium (RPE) is fundamental to normal function of retina. Malfunctioning of RPE contributes to the onset and advance of retinal degenerative diseases. Up to date, RPE replacement therapy is the only possible method to completely reverse retinal degeneration. Transplantation of human RPE stem cell-derived RPE (hRPESC-RPE) has shown some good results in animal models. With promising results in terms of safety and visual improvement, human embryonic stem cell-derived RPE (hESC-RPE) can be expected in clinical settings in the near future. Despite twists and turns, induced pluripotent stem cell-derived RPE (iPSC-RPE) is now being intensely investigated to overcome genetic and epigenetic instability. By far, only one patient has received iPSC-RPE transplant, which is a hallmark of iPSC technology development. During follow-up, no major complications such as immunogenicity or tumorigenesis have been observed. Future trials should keep focusing on the safety of stem cell-derived RPE (SC-RPE) especially in long period, and better understanding of the nature of stem cell and the molecular events in the process to generate SC-RPE is necessary to the prosperity of SC-RPE clinical application.

24 Amniotic membrane transplantation with topical interferon alfa-2b after excision of ocular surface squamous neoplasia

Hua-Tao Xie , Ying-Ying Zhang , Dong-Ling Jiang , Jun Wu , Jia-Song Wang , Ming-Chang Zhang

2018, 11(1):160-162. DOI: 10.18240/ijo.2018.01.24

[Abstract](1739) [HTML](260) [PDF 908.67 K](677)

Abstract:
To evaluate the outcome of amniotic membrane transplantation (AMT) after tumor excision followed by topical interferon alfa-2b (IFNα2b) drops for primary ocular surface squamous neoplasia (OSSN). Twelve eyes of 12 patients with a mean age of 66±10y were included. The average follow-up was 23±10mo. All 12 patients had limbal involvement. Smooth ocular surface and transparent cornea were achieved in all cases. No sign of inflammation, neovascularization, symblepharon or recurrence was noted at the last follow-up. We conclude that AMT with topical IFNα2b drops restores a healthy ocular surface in OSSN without recurrence.

25 Prevalence of glaucoma in the Israeli Arab population

Otzem Chassid , Irena Epstein , Adi Sharabi-Nov , Joseph Pikkel

2018, 11(1):163-165. DOI: 10.18240/ijo.2018.01.25

[Abstract](1317) [HTML](253) [PDF 255.20 K](664)

Abstract:
We describe the prevalence and treatment of glaucoma in a Muslim Arab population in Israel. Based on the medical records of 15 122 persons, the overall prevalence of glaucoma was 3.9%. Prevalence rates of primary open angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) were 3.0% and 0.42%, respectively. Prevalence rates of women were 135% that of men considering all types of glaucoma, 143% for POAG, and 96% for PACG. Prostaglandin analogs and beta blockers, alone or combined with carbonic anhydrase inhibitors, were the preferred medications. Of 68 patients who underwent trabeculectomy, 27 (39.7%) required medications, postoperatively, for treatment of glaucoma; following Ex-Press shunt surgery, 3/11 (27.3%) required medications. During the last three years, 16 (1.3%) individuals with POAG were recorded as legally blind as a result of glaucoma.

26 Effect of two different doses of intravitreal bevacizumab with temporal retina-sparing laser photocoagulation for retinopathy of prematurity

A Young Choi , Hochan Cho , Yu Cheol Kim

2018, 11(1):166-169. DOI: 10.18240/ijo.2018.01.26

[Abstract](1788) [HTML](246) [PDF 331.42 K](666)

Abstract:
This study aims to compare the efficacy and safety between two different doses of intravitreal bevacizumab (IVB) injection with temporal retina-sparing laser (TRSL) photocoagulation for retinopathy of prematurity (ROP). We retrospectively evaluated 22 eyes of ROP infants who underwent IVB combined with partial TRSL for stage 3+ zone I or posterior zone II ROP. Laser photocoagulation was applied on the avascular retina, sparing two-disc-diameter width temporal avascular area anterior to ridge. A half dose (0.625 mg) or minimal dose (0.25 mg) of IVB was conducted. Four eyes in minimal dose group were retreated with IVB and laser photocoagulation on the spared retina. Of those 4 retreated eyes, three developed preretinal hemorrhage around the ridge after the first treatment, resulting in fibrotic macular dragging. A half dose of IVB may be more effective than a minimal dose with partial TRSL for ROP. Preretinal hemorrhage may be a harbinger of poor prognosis.

27 Tissue plasminogen activator-assisted vitrectomy in the early treatment of acute massive suprachoroidal hemorrhage complicating cataract surgery

Ping Fei , Hai-Ying Jin , Qi Zhang , Xin Li , Pei-Quan Zhao

2018, 11(1):170-171. DOI: 10.18240/ijo.2018.01.27

[Abstract](1741) [HTML](0) [PDF 774.47 K](639)

Abstract:

28 A new treatment option for the resistant spasm of accommodation: clear lens extraction and multifocal intraocular lens implantation

Ozgun Melike Gedar Totuk , Umit Aykan

2018, 11(1):172-174. DOI: 10.18240/ijo.2018.01.28

[Abstract](2654) [HTML](0) [PDF 244.83 K](662)

Abstract:

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Volume 11,Issue 1,2018 Table of Contents