Volume 11,Issue 12,2018 Table of Contents

Lei Tian , Ning-Li Wang

2018, 11(12):1887-1888. DOI: 10.18240/ijo.2018.12.01

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Abstract:
As a contagious bacterial infection that affects the conjunctival covering of the eye, the cornea and the eyelids, trachoma is controlled by an endorsed integrated strategy consisting of surgery for trichiasis, antibiotic therapy, facial cleanliness and environmental improvement, namely, the SAFE strategy developed by World Health Organization. Developed based on evidence from previous field trials and constantly modified in practice, SAFE strategy has greatly boosted the progress in trachoma control. Regardless of the fact that there are still many pending questions, national program coordinators are convinced that trachoma control initiative based on SAFE strategy would be effective.

2 Serum microRNA-221 as a biomarker for diabetic retinopathy in patients associated with type 2 diabetes

He-Nan Liu , Xun Li , Na Wu , Meng-Meng Tong , Shuo Chen , Shan-Shan Zhu , Wei Qian , Xiao-Long Chen

2018, 11(12):1889-1894. DOI: 10.18240/ijo.2018.12.02

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Abstract:
AIM: To investigate the candidate microRNA (miRNA), miR-221 as a novel biomarker for diabetic retinopathy (DR) in patients associated with type 2 diabetes (T2D). METHODS: The subjects involved were divided into four groups: healthy control (HC), no diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) group. Serum miR-221 was validated by real-time quantitative reverse-transcription polymerase chain reaction (qRT-PCR). Also, serum angiotensin II (Ang II) and vascular endothelial growth factor (VEGF) were examined by enzyme-linked immunosorbent assay. In addition, receiver operating characteristic (ROC) curve was performed to explore the diagnostic accuracy of miR-221, Ang II and VEGF for DR in patients with T2D. Spearman’s rank correlation coefficient was executed to estimate the correlations of serum miR-221 with metabolic parameters and serum markers in patients with T2D. RESULTS: Primarily, serum miR-221, Ang II and VEGF were increased significantly in T2D patients compared to HC participant respectively, and progressive up-regulated in NDR, NPDR and PDR groups (P<0.001). Additionally, miR-221 in serum was remarkably positively correlated with metabolic parameters such as glycated hemoglobin (r=0.310, P=0.002) and homeostasis model assessment for insulin resistance (r=0.413, P<0.001), as well as serum markers for instance Ang II (r=0.667, P<0.001) and VEGF (r=0.499, P<0.001). Furthermore, serum miR-221 (AUC, 0.894; 95%CI, 0.833-0.955; P<0.001), Ang II (AUC, 0.888; 95%CI, 0.828-0.949; P<0.001) and VEGF (AUC, 0.785; 95%CI, 0.695-0.875; P<0.001) had evidently diagnostic efficiency in DR, and miR-221 is the most effective among them. CONCLUSION: Serum miR-221 as a potential biomarker could be related to not only occurrence but also progression for DR in patients with T2D. However, a prospective clinical trial is warranted.

3 In vitro adherence of conjunctival bacteria to different oculoplastic materials

Alvaro Toribio , Honorina Martínez-Blanco , Leandro Rodríguez-Aparicio , Miguel Á. Ferrero , Teresa Marrodán , Isabel Fernández-Natal

2018, 11(12):1895-1901. DOI: 10.18240/ijo.2018.12.03

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Abstract:
AIM: To investigate the resistance to bacterial adhesion of materials used in oculoplastic surgery, particularly materials used in the manufacture of orbital implants. METHODS: Seven organisms of conjunctival flora (two strains of Staphylococcus epidermidis and one strain each of Staphylococcus aureus, Staphylococcus hominis, Corynebacterium amycolatum, Acinetobacter calcoaceticus, and Serratia marcescens) were selected. A lactic acid bacterium (Lactobacillus rhamnosus) was also included as positive control because of its well-known adhesion ability. Eight materials used to make oculoplastic prostheses were selected (glass, steel, polytetrafluoroethylene, polymethylmethacrylate, silicone from orbital implants, commercial silicone, porous polyethylene, and semi-smooth polyethylene). Materials surfaces and biofilms developed by strains were observed by scanning electron microscopy. Kinetics of growth and adhesion of bacterial strains were determined by spectrophotometry. Each strain was incubated in contact with plates of the different materials. After growth, attached bacteria were re-suspended and colony-forming units (CFUs) were counted. The number of CFUs per square millimetre of material was statistically analyzed. RESULTS: A mature biofilm was observed in studied strains except Staphylococcus hominis, which simply produced a microcolony. Materials showed a smooth surface on the microbial scale, although steel exhibited 1.0-μm-diameter grooves. Most organisms showed significant differences in adhesion according to the material. There were also significant differences in the total number of CFUs per square millimetre from each material (P=0.044). CFU counts were significantly higher in porous polyethylene than in silicone from orbital implants (P=0.038). CONCLUSION: Silicone orbital implants can resist microbial colonization better than porous polyethylene implants.

4 Ocular surface heat effects on ocular hemodynamics detected by real-time measuring device

Ting-Ting Li , Guang-Bin Shao , Yu-Long Jiang , Jing-Xuan Wang , Xin-Rong Zhou , Min Ren , Long-Qiu Li

2018, 11(12):1902-1908. DOI: 10.18240/ijo.2018.12.04

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Abstract:
AIM: To investigate the ocular hemodynamic effects of applying a hot compress to the eye. METHODS: The right eyes of five New Zealand white rabbits, both male and female, were hot-compressed for 18min. An independently designed novel ocular contact-type temperature measuring device was used to measure the ocular surface temperature before and after the heating. Relevant retrobulbar hemodynamic parameters such as peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) of each of the central retinal artery (CRA), long posterior ciliary artery (LPCA), and ophthalmic artery (OA), as well as the mean velocity (Vm) of the central retinal vein (CRV), were measured using a color Doppler flow imaging (CDFI) technique and expressed as mean values with standard deviation (mean±SD). A statistical analysis was conducted based on a paired t-test and the Wilcoxon signed-rank test. RESULTS: The employed real-time temperature measuring device was able to accurately measure ocular surface temperature during the hot-compress process. The temperature increased after the hot compress was applied. Analysis showed that the PSV and EDV values of the CRA and LPCA significantly increased after the application of the hot compress, as did the Vm of the CRV. There were no significant changes in the EDV of the OA nor the RI of each artery. CONCLUSION: This experiment, which is the first of its kind, confirms that the retrobulbar blood flow velocities can increase upon heating the ocular surface. This simple method may be useful in the future.

5 The effect on wound healing of pazopanib and bevacizumab compared with corticosteroid in experimental glaucoma filtration surgery

Sabiha Gungor Kobat , Fatma Ulku Celiker , Adile Ferda Dagli , Kader Kasar

2018, 11(12):1909-1915. DOI: 10.18240/ijo.2018.12.05

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Abstract:
AIM: To compare the effects of bevacizumab and pazopanib with corticosteroids on wound healing after trabeculectomy. METHODS: In the study, 35 New Zealand white rabbits were randomly divided into five groups. Apart from the first group, limbus-based trabeculectomy was performed for the eyes of rabbits. No postoperative treatment was administered for group I. Topically administered saline, prednisolone acetate (1%), bevacizumab 5 mg/mL, pazopanib 5 mg/mL for group II, III, IV and V respectively were applied for groups 6h daily for 28d. On day 28 of the experiment, eyes were enucleated and histologically and immunohistochemically analyzed. RESULTS: The fibroblast counts of groups IV and V were determined to be lower than those of groups II and III (P<0.05). In the mononuclear cell (MNC) count evaluation, no statistically significant difference was determined between the treatment groups (P>0.05). The immunohistochemical staining intensity of fibroblast growth factor β (FGF-β) and vascular endothelial growth factor (VEGF) was determined to be lower in groups IV and V than in groups II and III (P<0.05). No statistically significant difference was determined between groups IV and V in respect of fibroblast count, MNC count, FGF-β and VEGF staining intensity (P>0.05). The platelet derived growth factor β (PDGF-β) intensity was lower in group V than in groups II, III and IV (P<0.05). While the PDGF-β staining intensity was significantly lower in group IV than in group II, the difference compared with group III was not statistically significant (P>0.05). CONCLUSION: Bevacizumab and pazopanib might be good alternatives of corticosteroid treatment on delaying wound healing in glaucoma surgery.

6 Recombination and identification of human alpha B-crystallin

Rui Wang , Ze-Hua Chen , Yi Wang , Hou-Bin Huang , Si-Jun Fan , Lan-Lan Chen

2018, 11(12):1916-1921. DOI: 10.18240/ijo.2018.12.06

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Abstract:
AIM: To recombine the human alpha B-crystallin (αB-crystallin) using gene cloning technology and prokaryotic expression vector and confirm the biological activity of recombinant human αB-crystallin. METHODS: Cloning the human αB-crystallin cDNA according to the nucleotide sequence of the human αB-crystallin, constructing the pET-28/CRYAB prokaryotic expression plasmid by restriction enzyme digestion method, and stably expressing transformed into the Escherichia coli (E. coli) DH5 alpha. The recombinant human αB-crystallin was purified by Q sepharose. By enzyme digestion analysis, Western blotting and sequencing, the recombinant human αB-crystallin was identified and the activity of its molecular protein was detected. RESULTS: Compared with the gene bank (GeneBank), the cloned human sequence of human αB-crystallin cDNA has the same open reading frame. Identification and sequencing of the cloned human αB-crystallin cDNA in prokaryotic expression vector confirmed the full length sequence, and the vector was constructed successfully. The E. coli containing plasmid pET-28/CRYAB induced by isopropyl-β-D-thiogalactoside successfully expressed the human αB-crystallin. Insulin confirmed that the recombinant human αB-crystallin has a molecular chaperone activity. CONCLUSION: The prokaryotic expression vector pET-28/CRYAB of recombinant human αB-crystallin is successfully constructed, and the recombinant human αB-crystallin with molecular chaperone activity is obtained, which lay a foundation for the research and application of the recombinant human αB-crystallin and its chaperone activity.

7 Surgical outcome and patient satisfaction after Z-epicanthoplasty and blepharoplasty

Jing-Yi Zhao , Xiao-Shuang Guo , Guo-Dong Song , Xian-Lei Zong , Xiao-Nan Yang , Le Du , Chen-Zhi Lai , Zuo-Liang Qi , Xiao-Lei Jin

2018, 11(12):1922-1925. DOI: 10.18240/ijo.2018.12.07

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Abstract:
AIM: To evaluate surgical outcomes of modified Z-epicanthoplasty with blepharoplasty that we previously reported from the patient’s perspective using patient-reported outcome measures (PROMs) and patient satisfaction scores. METHODS: A total of patients (n=180) who underwent the surgery between January 2013 and June 2016 were randomly selected. Standardized patient satisfaction forms (total score, 40) and validated PROMs questionnaires (total score, 12) were sent to patients for completion. PROMs assesses the severity of scarring, pain and asymmetry, as well as functional and appearance issues. RESULTS: All patients were female, ranging from 18 to 35 years old (mean=24). The response rate was 73.3% (n=132). The majority of patients reported good or excellent outcomes based on PROM analysis. Patients reported minimum or non-visible scarring at both the double eyelid surgical scar (85.6%) and the inner canthus (80.3%). Issues concerning function and appearance were minimal as 80.3% reported satisfaction with both domains. Notably, the majority of patients reported either a high or very high satisfaction rate to yield a mean score of 104 out of 120 (P<0.05). CONCLUSION: Integration of our modified Z-epicanthoplasty with blepharoplasty produces good outcomes based on PROM results, which shows a positive linear relationship with patient satisfaction scores.

8 Factors influencing subjective symptoms in dry eye disease

Hidenaga Kobashi , Kazutaka Kamiya , Takehiko Sambe , Ryutaro Nakagawa

2018, 11(12):1926-1931. DOI: 10.18240/ijo.2018.12.08

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Abstract:
AIM: To retrospectively investigate the association between dry eye symptoms and clinical or in vivo confocal microscopy parameters in patients with dry eye disease (DED), and to compare these parameters between eyes with DED and normal subjects. METHODS: This retrospective, cross-sectional, controlled study comprised 25 consecutive patients with non-Sjögren dry eye disease and age- and sex-matched 25 healthy subjects. Each patient underwent a complete examination of the ocular surface in the following order: tear osmolarity measurements, InflammaDry test, tear break-up time, corneal fluorescein staining, Schirmer I test, subjective symptoms questionnaire using the dry eye-related quality-of-life score (DEQS), and in vivo confocal microscopy analysis of the central cornea. Beck depression inventory (BDI) as depressive scale and history of medications and smoking were also evaluated. Stepwise multiple regression analysis was used to assess the factors affecting the DEQS. RESULTS: In univariate analysis, DEQS was associated with tear break-up time (ρ=-0.48, P=0.01), oral medications, such as hypotensive drug (ρ=0.56, P=0.004) and anti-depressant (ρ=0.57, P=0.003), and BDI (ρ=0.61, P=0.001) in patients with DED. In multiple regression analysis, explanatory variables relevant to the DEQS were the anti-depressant medications (P=0.04, partial regression coefficient B=21.04) and BDI (P=0.02, B=0.76, adjusted R2=0.54) in these patients. CONCLUSION: Our study shows a significant association between depression and dry eye symptoms. It suggests that dry eye symptoms associate with higher depressive symptoms and its medications, although our patients were not followed longitudinally.

9 Intracameral lidocaine as supplement to classic topical anesthesia for relieving ocular pain in cataract surgery

Marcella Nebbioso , Maria Luisa Livani , Valentina Santamaria , Aloisa Librando , Massimiliano Sepe

2018, 11(12):1932-1935. DOI: 10.18240/ijo.2018.12.09

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Abstract:
AIM: To evaluate safety, efficacy, and patient adherence of intracameral lidocaine as supplement of classic topical anesthetic drops in cataract surgery. METHODS: A prospective and controlled trial including a large cohort of 1650 individuals suffering with bilateral cataract not complicated, in program by phacoemulsification surgery, were randomly assigned to 2 different groups for the type of anesthesia received, 0.4% oxybuprocaine hydrochloride (INN) drops, and INN drops associated to intracameral 1% lidocaine hydrochloride monohydrate. At the end of surgery, tables were assigned to each patient indicating the degree of pain (0-3) felt during the operation. RESULTS: Thirty-two percent of patients in group 1 declared to have not felt any pain against the 77% of patients in group 2. Fifty-nine percent of patients in group 1 complained about only a slight discomfort against 20% of group 2 patients. Only a small percentage of patients in group 1 (5%) admitted severe pain, while no patient in group 2 admitted severe pain. Four patients of group 2 reported an episode of transient amaurosis, lasting several hours after surgery. CONCLUSION: Intracameral administration of lidocaine is a simple and secure method able to increase the analgesia during the cataract surgery, eliminating the discomfort and increasing also the cooperation of the patients during the steps of manipulation.

10 Effectiveness of 0.1% topical salicylic acid on blepharoconjunctivitis affecting glaucoma patients treated with topical prostaglandin analogues: a prospective randomized trial

Aloisa Librando , Sandra Cinzia Carlesimo , Giorgio Albanese , Giuseppe Maria Albanese , Raffaele Migliorini , Elena Pacella

2018, 11(12):1936-1940. DOI: 10.18240/ijo.2018.12.10

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Abstract:
AIM: To evaluate the efficacy of 0.1% topical salicylic acid (TSA) to treat iatrogenic chronic blepharoconjunctivitis in patients with primary open angle glaucoma (POAG), treated with topical prostaglandin analogues (TPAs). METHODS: Totally 60 patients were randomly distributed into 3 equal size groups, two of which treated with 0.1% TSA (OMKASA®) and 0.1% topical clobetasone butyrate (TCB; VISUCLOBEN®) respectively, and one consisting of untreated controls. The parameters taken into account at baseline (T0) and after 30d (T1) of therapy were: conjunctival hyperemia, lacrimal function tests [Schirmer I test and break up time (BUT)] and intraocular pressure (IOP). RESULTS: Conjunctival hyperemia showed a substantial improvement in both treated groups (P<0.001) but not among controls. Similarly, lacrimal function tests displayed an improvement of Schirmer I test in both treated groups (P<0.05) and an extension of BUT only in the group treated with 0.1% TSA (P<0.05). The IOP increase was statistically significant only in those patients treated with 0.1% TCB (P<0.001). CONCLUSION: The 0.1% TSA has proved to be an effective anti-inflammatory treatment of blepharoconjunctivitis affecting glaucoma patients on therapy with TPAs, leading to a sizeable decrease of inflammation as well as both quantitative and qualitative improvement of tear film. Furthermore, differently from 0.1% TCB, it does not induce any significant IOP increase.

11 XEN® implant and trabeculectomy medium-term quality of life assessment and comparison of results

Ana Luísa Basílio , Nuno Moura-Coelho , Inês Passos , Mariana Sá Cardoso , Isabel Domingues , Maria Reina , Rita Flores , Teresa Gomes

2018, 11(12):1941-1944. DOI: 10.18240/ijo.2018.12.11

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Abstract:
AIM: To evaluate and compare the quality of life of patients submitted to XEN® implant or trabeculectomy and the relationship with potentially involved variables. METHODS: A cross-sectional study of patients with advanced open-angle glaucoma who underwent implantation of XEN® (group 1) and trabeculectomy (group 2) between October 2015 and February 2017. The studied variables were: age, gender, follow-up time, need of topical anti-hypertensive therapy, visual acuity and intraocular pressure (IOP). The quantification of the quality of life was attained through the Glaucoma Symptom Scale (GSS) questionnaire. RESULTS: Totally 34 eyes (34 patients) were included, 17 in each group. The mean GSS scores for group 1 were 42.6±6.8 (median, 47; p25, 36.5; p75, 48.5) and for group 2 it was 41.6±7.0 (median, 43; p25, 36.5; p75, 47.0; P=0.34). There was a strong negative correlation between the need for topical anti-hypertensive drugs and the GSS result in both groups (r=-0.88, P<0.01, r=-0.59, P=0.01, respectively) and a moderate negative correlation with IOP in group 1 (r=-0.50, P=0.03). CONCLUSION: The analysis demonstrates the non-inferiority of medium-term quality of life of one group in relation to the other (XEN® implant and trabeculectomy). The number of topical anti-hypertensive drugs and IOP negatively influenced the quality of life.

12 Long term follow-up of a family with GUCY2D dominant cone dystrophy

Georgios Tsokolas , Hussein Almuhtaseb , Helen Griffiths , Fatima Shawkat , Reuben J. Pengelly , Sarah Ennis , Andrew Lotery

2018, 11(12):1945-1950. DOI: 10.18240/ijo.2018.12.12

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Abstract:
AIM: To describe long term follow-up in a family with GUCY2D dominant cone dystrophy. METHODS: Optical coherence tomography scans and fundus autofluorescence images were obtained. Flash and pattern electroretinograms (ERGs) and occipital pattern reversal visual evoked potentials were recorded. RESULTS: Two members of the same family (father and son) were identified to have the heterozygous R838C mutation in the GUCY2D gene. The father presented at the age of 45 with bilateral bull’s eye maculopathy and temporal disc pallor. Over 13y of serial follow up visits, the bull’s eye maculopathy progressed gradually into macular atrophy. Electrophysiological tests were significantly degraded suggesting poor macular function. Spectral-domain optical coherence tomography (SD-OCT) scans showed progressive loss and disruption of the ellipsoid layer at the foveal level. His son presented at the age of 16 with bilateral granular retinal pigment epithelial changes in both maculae. Electrophysiological testing was initially borderline normal but has gradually deteriorated to show reduced cone ERGs and macula function. SD-OCT demonstrated gradual macular thinning and atrophy bilaterally. Unlike his father, there was no disruption of the ellipsoid layer. CONCLUSION: Both family members exhibited gradual changes in their fundi, electrophysiological testing and multimodal imaging. Changes were milder than those observed in other mutations of the same gene.

13 Treatment of refractory diabetic macular edema with a fluocinolone acetonide implant in vitrectomized and non-vitrectomized eyes

Alberto La Mantia , Alan Hawrami , Heidi Laviers , Sudeshna Patra , Hadi Zambarakji

2018, 11(12):1951-1956. DOI: 10.18240/ijo.2018.12.13

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Abstract:
AIM: To report real-life data on the use of an intravitreal fluocinolone acetonide implant in the treatment of refractory diabetic macular edema (DME) in pars plana vitrectomized (PPV) and non-PPV eyes. METHODS: This was a comparative retrospective observational study of 23 eyes with chronic DME. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded at baseline, 1, 4 and 12mo. Descriptive statistics and non-parametric tests were performed to analyze and compare PPV and non-PPV eyes. RESULTS: Seven PPV and 16 non-PPV eyes were included in the study. Median BCVA in the non-PPV group varied from 0.65 logMAR [Interquartile range (IQR): 0.40] at baseline to 0.42 logMAR (IQR: 0.40) at 12mo. Median CMT varied from 430 µm (IQR: 131.3) at baseline to 317 µm (IQR: 107.5) at 12mo. Median BCVA in the PPV group varied from 0.60 logMAR (IQR: 0.62) at baseline to 0.74 logMAR (IQR: 0.34) at 12mo. Median CMT varied from 483 µm (IQR: 146) at baseline to 397 µm (IQR: 132) at 12mo. Of 0/7 eyes and 1/16 eyes in the PPV and non-PPV eyes respectively had a baseline visual acuity of 6/12 or better (0.3 logMAR). At last follow up, 1/7 and 5/16 eyes in the PPV and non-PPV group respectively achieved a visual acuity of 6/12 or better. CONCLUSION: Visual outcomes are modest following the use of the fluocinolone acetonide implant for chronic DME. The steroid implant is a useful treatment option in the management of refractory DME in vitrectomized and non-vitrectmized eyes.

14 The thickness and volume of the choroid, outer retinal layers and retinal pigment epithelium layer changes in patients with diabetic retinopathy

Xiang-Ning Wang , Shu-Ting Li , Wei Li , Yan-Jun Hua , Qiang Wu

2018, 11(12):1957-1962. DOI: 10.18240/ijo.2018.12.14

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Abstract:
AIM: To evaluate the thickness and volume changes of the choroidal, outer retinal layers (ORL) and retinal pigment epithelium (RPE) in patients with diabetic retinopathy (DR) using optical coherence tomography (OCT) and correlate them with visual acuity. METHODS: We carried out a retrospective observational case series. Consecutive DR patients were recruited for color fundus photography and OCT assessment. The RPE, ORL and choroidal thickness were measured. The correlation with the best-corrected visual acuity (BCVA) was also investigated. RESULTS: The study included 128 eyes, comprising 45 eyes of 25 diabetic macular edema (DME) patients, 34 eyes of 20 DR without DME (non-DME) patients, and 49 eyes of 25 age-matched normal individuals. The choroidal thickness in DR patients were decreased statistically significantly compared with the control group (P<0.05). The mean macular ORL thickness in DME (73.02±15.34 μm) and non-DME groups (76.35±7.32 μm) were decreased statistically significantly compared with the control group (80.20±5.85 μm; P=0.006, P=0.013, respectively). In both the non-DME and DME groups, the RPE thickness were decreased compared with the control group (P<0.05), except in the macular and central ring. The BCVA were significant interactions with the total inner retinal volume and macular RPE thickness in the DME group (r=0.115, P<0.001, r=-0.013, P=0.017, respectively). CONCLUSION: The choroid, ORL and RPE thickness are significantly decreased in DR patients compared with controls in different segments.

15 Relation between preoperative hyperopia and surgical outcome in infantile esotropia

Haeng Jin Lee , Jeong-Ah Kim , Seong-Joon Kim , Young Suk Yu

2018, 11(12):1963-1967. DOI: 10.18240/ijo.2018.12.15

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Abstract:
AIM: To evaluate the relation between preoperative hyperopia and surgical outcomes of infantile esotropia in patients younger than 24 months of age. METHODS: Medical records of patients who underwent bilateral medial rectus muscle recession for infantile esotropia between November 1, 2002 and December 1, 2011 were retrospectively reviewed. Patients were divided into two groups according to the degree of preoperative hyperopia. Group I had less than +3.0 diopter (D) of hyperopia and group II had between +3.0 and +5.0 D of hyperopia. Postoperative alignments were evaluated 1wk, 3, 6mo, and 1y after surgery. Following the 1-year postoperative visit, patients were monitored yearly. Relationships between preoperative factors including hyperopia and postoperative outcomes were evaluated. RESULTS: Forty-six patients were included, with 33 patients in group I and 13 patients in group II. The preoperative mean refractive error was +0.88 D in group I and +3.45 D in group II. Surgical outcomes were not significantly different between groups at any postoperative time point examined. Cumulative probability of surgical success, prevalence of inferior oblique overaction, dissociated vertical deviation, and re-operation rate were not significantly different between groups. CONCLUSION: Preoperative moderate hyperopia (less than +5.0 D) did not affect the surgical outcome of infantile esotropia. Therefore, the surgical correction of esotropia should be considered when the angle of esodeviation is unchanged following hyperopia correction, even in children with moderate hyperopia.

16 Prevalence of visual impairment and related factors in Nangarhar Province of Afghanistan: a cross sectional study

Mohammad Haris Abdianwall , Bahar Güçiz Do&gbreve;an

2018, 11(12):1968-1977. DOI: 10.18240/ijo.2018.12.16

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Abstract:
AIM: To determine the prevalence, main causes, and related factors of visual impairment (VI) among people aged 50y and over in Jalalabad City and four surrounding districts of Nangarhar Province of Afghanistan. METHODS: The data for the population based cross-sectional study was collected in 2015. The calculated sample size was 1353, allocated to urban-rural strata using probability proportion to size method. At the end of the study, 1281 people participated in to the study. VI was defined as presenting visual acuity (VA) of less than 6/18 and blindness as VA less than 3/60 in the better eye by using Snellen chart only. Data was analyzed using IBM SPSS 21.0 software. RESULTS: The prevalence of VI was 22.6% (95%CI, 20%-25%) of which 13.9% (95%CI, 12%-16%) was low vision and 8.7% (95%CI, 7%-10%) was blindness. The most common causes of the VI were cataract (52.8%), followed by uncorrected refractive error (URE) (26.9%) and glaucoma (8.6%). Number one cause of the low vision was URE (42%), followed by cataract, glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy (DR), while for blindness they are cataract (72%), other posterior segment disorders, glaucoma, URE and AMD. Illiteracy, bad economic status, hypertension and overweight were factors independently associated with both VI and low vision, whereas, age, illiteracy, bad economic status, hypertension and using of sunglasses were independently associated with blindness. CONCLUSION: Cataract, URE, glaucoma, AMD and DR are the leading causes of VI and blindness in the study area. They are mostly avoidable. In order to decrease the burden of VI and blindness in the study area as well as the whole country, it is strongly recommended to apply the prevention policies of VI and blindness.

17 Visual field mean deviation and relevant factors in 928 Chinese retinitis pigmentosa patients

Hui Ye , Xiao-Ping Xia

2018, 11(12):1978-1983. DOI: 10.18240/ijo.2018.12.17

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Abstract:
AIM: To investigate the associations between demographic and clinical factors with the rate of visual field mean derivation (MD) decline in retinitis pigmentosa (RP) patients. METHODS: Correlations of MDs with the visual acuity and retinal pigmentation were analyzed in 928 RP patients. MD decreasing rate in 10y and potential influences of gender, age, family history and retinal pigmentation on the rate were explored in 201 RP patients. RESULTS: In the 928 patients, average MD and visual acuity were -14.44±8.61 dB and 0.79±0.35 respectively and when MD was lower than -9.18 dB the visual acuity would be below 1.0 (20/20). The average MD medium between eyes with or without retinal pigmentation was -14.82 dB. In 123 non-pigmented eyes, the average MD were lower than the medium but in 153 pigmented eyes it was higher than that. In the 201 patients, the average decreasing value of MD in 10 years’ period was -8.01±3.66 dB and the value were correlated to retinal pigmentation but not to gender, age or RP family history. CONCLUSION: The rate of MD decline in RP eyes is significantly related to retinal pigmentation. Our study demonstrates the quantitative rate of MD decline in RP patients and the value of MD could well reflect the severity of RP.

18 Comparison of bilateral/unilateral lateral rectus recession and unilateral recession-resection for intermittent exotropia: a Meta-analysis

De-Sheng Song , Zhi-Jun Chen , Jing Qian

2018, 11(12):1984-1993. DOI: 10.18240/ijo.2018.12.18

[Abstract](1565) [HTML](278) [PDF 1.22 M](561)

Abstract:
AIM: To compare the effectiveness of unilateral recession- resection (R&R) and bilateral/unilateral recession (BLR/ULR) for treatment of basic type of intermittent exotropia [IX(T)]. METHODS: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library, to identify randomized controlled trials and comparative studies regarding the effectiveness of R&R and BLR/ULR for IX(T). Based on which, a Meta-analysis was then performed in terms of long-term success rate, overcorrection rate, and recurrence rate. RESULTS: Nine studies in total satisfy the specified eligibility criteria. BLR is at disadvantage to R&R at a short-term follow-up [<2y, OR 0.56 (0.33-0.94) for success rate; OR 2.11 (1.17, 3.81) for undercorrection rate]. However, BLR achieved a higher success rate [OR 2.49 (1.61, 3.86)] and a lower undercorrection rate [OR 0.40 (0.23, 0.71)], compared to that of R&R at a long-term follow-up (>2y). There is no significant difference was found in overcorrection rate, regardless of the length of follow-up time [OR 0.85 (0.41, 1.75)]. In the treatment for small-angle IX(T), the final outcome was significantly different between the groups, demonstrating a more successful alignment [OR 0.37 (0.18, 0.74)] and a lower undercorrection [OR 3.50 (1.28, 7.26)] in the R&R group than in the ULR group. While for moderate-angle IX(T) (20 PD-25 PD), the effectiveness of R&R and ULR is quite equivalent with similar success rate [OR 1.08 (0.65, 1.79)] and undercorrection rate [OR 0.89 (0.54, 1.48)]. CONCLUSION: As regard to the effect of BLR and R&R, R&R shows an advantage over BLR at short term. But, BLR is more effective in the long term for the basic type IX(T) in children. R&R surgery should be a better choice for the treatment of small-angle IX(T) of ≤20 PD than ULR. However, both of ULR and R&R are recommended for moderate-angle IX(T) from 20 PD to 25 PD.

19 Top 100 cited articles in ophthalmic epidemiology between 2006 and 2016

Lei Liu , Yan Li , Gui-Sen Zhang , Jing-Yang Wu , Shivani Majithia , Yih-Chung Tham , Han Zhang , Lei Chen

2018, 11(12):1994-1998. DOI: 10.18240/ijo.2018.12.19

[Abstract](1928) [HTML](262) [PDF 358.62 K](593)

Abstract:
AIM: To identify the most-cited articles in ophthalmic epidemiology over the last decade. METHODS: We performed a cited reference search on articles that were included in the ISI Web of Science database using the terms “Epidemi*” AND “ophthalm*” AND “population*” during year 2006 to 2016. TOP 100 most cited articles (T100) in ophthalmic epidemiology were short listed and analysed using bibliometrics. RESULTS: These top 100 articles in ophthalmic epidemiology were cited between 61 to 333 times. Of these T100 articles, 36% originated from United States, and 34% were published in the Ophthalmology journal. The three major topics identified were age-related macular degeneration (AMD, n=23), glaucoma (n=16) and visual impairment (n=12). The top-cited article was a study on outdoor activities and its association with the prevalence of myopia in school-aged children, published in 2008. CONCLUSION: This bibliometric analysis provides useful insights into the current development in ophthalmic epidemiology in the past decade and can help recognizing the quality of the researches, discoveries, and trends steering ophthalmic epidemiology.

20 Research progress about the effect and prevention of blue light on eyes

Zhi-Chun Zhao , Ying Zhou , Gang Tan , Juan Li

2018, 11(12):1999-2003. DOI: 10.18240/ijo.2018.12.20

[Abstract](13522) [HTML](495) [PDF 290.71 K](2613)

Abstract:
In recent years, people have become increasingly attentive to light pollution influences on their eyes. In the visible spectrum, short-wave blue light with wavelength between 415 nm and 455 nm is closely related to eye light damage. This high energy blue light passes through the cornea and lens to the retina causing diseases such as dry eye, cataract, age-related macular degeneration, even stimulating the brain, inhibiting melatonin secretion, and enhancing adrenocortical hormone production, which will destroy the hormonal balance and directly affect sleep quality. Therefore, the effect of Blu-rays on ocular is becoming an important concern for the future. We describe blue light’s effects on eye tissues, summarize the research on eye injury and its physical prevention and medical treatment.

21 Induced pluripotent stem cells as a potential therapeutic source for corneal epithelial stem cells

Jie Zhu , Mark Slevin , Bao-Qiang Guo , Shou-Rong Zhu

2018, 11(12):2004-2010. DOI: 10.18240/ijo.2018.12.21

[Abstract](2020) [HTML](273) [PDF 293.16 K](587)

Abstract:
Corneal blindness caused by limbal stem cell deficiency (LSCD) is one of the most common debilitating eye disorders. Thus far, the most effective treatment for LSCD is corneal transplantation, which is often hindered by the shortage of donors. Pluripotent stem cell technology including embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs) have opened new avenues for treating this disease. iPSCs-derived corneal epithelial cells provide an autologous and unlimited source of cells for the treatment of LSCD. On the other hand, iPSCs of LSCD patients can be used for iPSCs-corneal disease model and new drug discovery. However, prior to clinical trial, the efficacy and safety of these cells in patients with LSCD should be proved. Here we focused on the current status of iPSCs-derived corneal epithelial cells used for cell therapy as well as for corneal disease modeling. The challenges and potential of iPSCs-derived corneal epithelial cells as a choice for clinical treatment in corneal disease were also discussed.

22 Update on pathology of retinoblastoma

Lata Singh , Seema Kashyap

2018, 11(12):2011-2016. DOI: 10.18240/ijo.2018.12.22

[Abstract](3194) [HTML](271) [PDF 317.75 K](803)

Abstract:
Retinoblastoma is caused by mutational inactivation of both alleles of the RB1 gene, which maps to chromosome 13q14 and encodes retinoblastoma protein that acts as a tumor suppressor. Histopathological high-risk features of retinoblastoma are predictive of metastasis or local recurrence. The focus of this update is to emphasize the recent advances in pathology, various molecular key pathways and genome wide approaches for newer potential therapeutic future targets associated with retinoblastoma tumor biology. This review article highlights the new biomarkers expressed by the retinoblastoma tumor for the better survival of patients.

23 Episcleral brachytherapy as an effective alternative in vasoproliferative tumors

Marta Para Prieto , Maria Antonia Saornil , Jesús María de Frutos Baraja , Ciro García Álvarez , Patricia Diezhandino García , Francisco López Lara

2018, 11(12):2017-2020. DOI: 10.18240/ijo.2018.12.23

[Abstract](1318) [HTML](250) [PDF 1.12 M](562)

Abstract:
The aim of this study is to assess the results of episcleral brachytherapy as treatment of retinal vasoproliferative tumors (RVTs) in a referral Intraocular Tumors Unit (ITU). A retrospective review of all patients diagnosed with vasoproliferative tumors of the retina and treated with episcleral brachytherapy in the ITU, University Hospital of Valladolid between 2009 and 2015 was done. Five patients accomplished the inclusion criteria. All of them presented associated exudation and secondary retinal detachments (RD). Four patients had received prior treatments. Decreased tumor size and exudation regression was found in all cases after treatment. Visual acuity remained stable or increased in all patients. No recurrences have been found after twelve-months follow up. The results of the present study suggest that episcleral brachytherapy is an efficient and safe option in the management of vasoproliferative tumors, especially when large tumor or extensive subretinal fluid is present. In these cases episcleral brachytherapy could be considered as a first line treatment.

24 Successively bilateral cytomegalovirus retinitis in immunocompromised patient with Good’s syndrome

Feng Hu , Yuan Du , Xiao-Yan Peng

2018, 11(12):2021-2023. DOI: 10.18240/ijo.2018.12.24

[Abstract](1264) [HTML](262) [PDF 718.37 K](551)

Abstract:

25 Treatment controversies in a rare case of a simultaneous branch retinal artery and vein occlusion secondary to hyperhomocysteinemia and hypertension

Panayiotis Christodoulou , Ioannis Katsimpris

2018, 11(12):2024-2026. DOI: 10.18240/ijo.2018.12.25

[Abstract](1155) [HTML](271) [PDF 741.17 K](550)

Abstract:

26 Botulinum toxin augmentation as a sequential procedure for residual esotropia in traumatic sixth nerve palsy

Hande Taylan Sekeroglu , Kadriye Erkan Turan , Ali Sefik Sanac

2018, 11(12):2027-2028. DOI: 10.18240/ijo.2018.12.26

[Abstract](1487) [HTML](256) [PDF 537.38 K](574)

Abstract:

27 Comment on “Intravitreal dexamethasone implants for diabetic macular edema”

Dan Călugăru , Mihai Călugăru

2018, 11(12):2029-2032. DOI: 10.18240/ijo.2018.12.27

[Abstract](1496) [HTML](263) [PDF 335.07 K](545)

Abstract:

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Volume 11,Issue 12,2018 Table of Contents