Volume 11,Issue 9,2018 Table of Contents

1 In vivo biodistribution of topical low molecular weight heparin-taurocholate in a neovascularized mouse cornea

Chan Hee Moon , Ji Yun Lee , Eun Soon Kim , Jin Hyoung Park , Sang-Yeob Kim , Jae Yong Kim , Hungwon Tchah

2018, 11(9):1435-1439. DOI: 10.18240/ijo.2018.09.01

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Abstract:
AIM: To investigate the ocular biodistribution and clearance of topically administered 7-taurocholic acid conjugated low-molecular weight heparin (LHT7) in a neovascularized mouse cornea using an in vivo optical imaging system. METHODS: A total of 10 eyes of 6 to 8-week-old BALB/c mice were analyzed. Corneal neovascularization (CoNV) was induced in the inferior cornea (IC) of each animal by penetrating the stroma with two interrupted sutures. The development of CoNV was verified after one week and the area of each neovascularized region was measured. A near-infrared fluorescent probe of 20 μmol/L Cy5.5 labeled LHT7 (LHT7-Cy5.5) in 0.02 mL solution was topically instilled onto the cornea in the experimental group (n=5). Free-Cy5.5 of 20 μmol/L in 0.02 mL was instilled in the control group (n=5). In vivo optical images were obtained before instillation and 5min, 2, 4, and 6h after instillation. The intensities were separately measured at the superior cornea (SC) and the IC. RESULTS: The mean CoNV areas were 1.97±0.17 mm2 and 1.92±0.96 mm2 in the experimental and control groups, respectively (P=0.832). The SC remained normal in all 10 subject animals. The IC intensity of the LHT7-Cy5.5 was greater than the SC intensity at 5min (P=0.038), 2h (P=0.041), and 4h (P=0.041) after application. The IC intensity fell to less than half of its initial value (42.9%±8.6%) at 6h in the experimental group. In the control mice, here were no significant differences in the free-Cy5.5 intensity between the IC and SC. CONCLUSION: Topically administered LHT7 shows a high biodistribution in CoNV areas for 4h and should be reapplied accordingly to maintain its effects. In vivo optical imaging can be a useful tool for evaluating the ocular biodistribution of a drug in an animal model.

2 Cell death and survival following manual and femtosecond laser-assisted capsulotomy in age-related cataract

Andrea Krisztina Sükösd , Judit Rapp , Diána Feller , György Sétáló Jr , Beáta Gáspár , Judit E. Pongrácz , Hajnalka Ábrahám , Zsolt Biró

2018, 11(9):1440-1446. DOI: 10.18240/ijo.2018.09.02

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Abstract:
AIM: To study molecular and morphological changes in lens epithelial cells following femtosecond laser-assisted and manually performed continuous curvilinear capsulotomy (CCC) in order to get information about these methods regarding their potential role in the induction of development of secondary cataract. METHODS: Anterior lens capsules (ALC) were removed from 40 patients with age-related cataract by manual CCC and by femtosecond laser-assisted capsulotomy (FLAC). Samples removed by manual CCC were assorted in group 1, FLAC samples were classified in group 2. Morphology of lens epithelial cells was examined with light and electron microscopes. Following capsulotomy, expressions of p53, Bcl-2 and cyclin D1 genes were analyzed with reverse transcriptase polymerase chain reaction. Immunohistochemistry was used to detect the pro-apoptotic p53 in the epithelial cells. RESULTS: Light and electron microscopic examination showed that ALC of group 1 contained more degenerating cells following manual CCC than after FLAC. The expression level of p53 was higher after manual than laser-assisted surgery. Immunocytochemistry indicated significantly higher number of cells containing p53 protein in the manual CCC group than following FLAC. Bcl-2 and cyclin D1 gene expression levels were slightly lower following manual CCC than after FLAC, but the difference was not significant. CONCLUSION: Manually removed ALC shows slightly, but not significantly larger damage due to the mechanical stretching and pulling of the capsule than those removed using FLAC.

3 Effects of LY294002 on the function of retinal endothelial cell in vitro

Yu Di , Xiao-Long Chen

2018, 11(9):1447-1450. DOI: 10.18240/ijo.2018.09.03

[Abstract](1016) [HTML](248) [PDF 764.34 K](680)

Abstract:
AIM: To study the effects of LY294002 [phosphatidylinositol 3-kinase (PI3K) inhibitor] on the function and mechanisms of retinal endothelial cells (RECs) in vitro. METHODS: RECs were randomly divided into control group and LY294002 treatment group. RECs in the control group were placed the incubator for hypoxic exposure in vitro. RECs in the LY294002 treatment group were pretreated with LY294002 (40 μmol/L) under hypoxic condition. The expression of matrix metalloproteinase (MMP)-2, MMP-9, vascular endothelial growth factor (VEGF), and apoptosis and proliferation of RECs were evaluated with Western blot, real-time reverse transcription-polymerase chain reaction (RT-PCR), and flow cytometric analysis, correspondently. RESULTS: Compared with the control group, treating the RECs with LY294002 was able to remarkably inhibit cell proliferation rates (t1d=2.13, t2d=2.65, t3d=2.36, t4d=2.06, all P<0.05). Flow cytometric analysis indicated that a moderate increase in apoptosis in the LY294002 treatment group compared to the control group (t=2.51, P<0.05). The expression of MMP-2, MMP-9 and VEGF were downregulated in the LY294002 treatment group by Western blot and real-time RT-PCR (all P<0.05). CONCLUSION: LY294002 regulates the function of RECs by reducing the expression of MMP-2, MMP-9, and VEGF in vitro. LY294002 may provide an effective method for preventing pathological angiogenesis.

4 Influence of polymorphisms in VEGF, ACE, TNF and GST genes on the susceptibility to retinopathy of prematurity among Chinese infants

Xiao-Jun Lei , Yong-Xia Zhao , Tong Qiao

2018, 11(9):1451-1457. DOI: 10.18240/ijo.2018.09.04

[Abstract](1289) [HTML](231) [PDF 356.56 K](554)

Abstract:
AIM: To investigate common polymorphisms in VEGF, ACE, TNF and GST genes with retinopathy of prematurity (ROP) risk among Chinese infants. METHODS: Nine polymorphisms in the above genes were genotyped on 724 advanced cases of ROP and 878 prematurely-born infants of low birth weight who were without any ophthalmologic disease. The frequencies of the polymorphisms were compared between cases and controls to identify the association present, if any. RESULTS: Of the nine polymorphisms, only two showed significant associations: ACE insertion deletion (ID) polymorphism (P=0.031) and TNF -308G/A polymorphism (P<0.001). The former was associated with a reduced ROP risk [ID genotype, adjusted OR (aOR): 0.603, 95%CI: 0.427-0.893, P=0.034; DD genotype, aOR: 0.468, 95%CI: 0.229-0.626, P=0.002], while the latter showed an increased risk (GA genotype, aOR: 1.956, 95%CI: 1.396-2.465, P<0.001; AA genotype, aOR: 2.809, 95%CI: 1.802-4.484, P<0.001). The association was also noted at the allele level (ACE D allele aOR: 0.698, 95%CI: 0.294-0.883, P<0.001; TNF -308A allele aOR: 1.776, 95%CI: 1.446-2.561, P<0.001). CONCLUSION: The ACE ID polymorphism can protect against ROP development while the TNF -308G/A can increase the risk of the disease among Chinese infants.

5 Frequency of IL-10-producing regulatory B cells associated with disease activity in thyroid-associated orbitopathy

Yun-Gang Ding , Guo Chen , Qian Li , Xiao-Feng Wen , Lai Wei , Hua-Sheng Yang

2018, 11(9):1458-1462. DOI: 10.18240/ijo.2018.09.05

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Abstract:
AIM: To investigate the association between IL-10-producing regulatory B (B10) cells and the clinical features of thyroid-associated orbitopathy (TAO). METHODS: A total of 30 patients with TAO were recruited at Zhongshan Ophthalmic Center from May 2015 to December 2015. Peripheral blood mononuclear cells (PBMCs) were separated from blood samples of 30 TAO patients and 16 healthy controls and stimulated with CD40 ligand and CpG for 48h. The frequency of IL-10+ B cells was examined by flow cytometry and the correlation between the frequency of IL-10+ B cells and clinical features of TAO was analyzed by SPSS. RESULTS: The frequency of IL-10+ B cells among CD19+ B cells in TAO patients was significantly lower than in healthy controls (TAO: 4.66%±1.88% vs healthy control: 6.82%±2.40%, P<0.01). The frequency of IL-10+ B cells showed a positive correlation with disease activity of TAO measured by Clinical Activity Score (CAS) (r=0.50, P<0.01), and became higher in TAO patients with family history of Graves’ disease (GD) (P=0.04). CONCLUSION: The decrease of the frequency of IL-10+ B cells in TAO patients indicates the deficiency of B10 cells in TAO, and the positive association with disease activity suggests its important role in TAO inflammation regulation.

6 Expression of multidrug-resistance associated proteins in human retinoblastoma treated by primary enucleation

Li-Juan Tang , Li-Jun Zhou , Wen-Xin Zhang , Jian-Yan Lin , Yong-Ping Li , Hua-Sheng Yang , Ping Zhang

2018, 11(9):1463-1466. DOI: 10.18240/ijo.2018.09.06

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Abstract:
AIM: To reveal the expression of multidrug-resistance associated proteins: glutathione-S-transferase π (GSTπ), P-glycoprotein (P-gp) and vault protein lung resistance protein (LRP) in retinoblastoma (RB) without any conservative treatment before primary enucleation and to correlate this expression with histopathological tumor features. METHODS: A total of 42 specimens of RB undergone primary enucleation were selected for the research. Sections from the formalin-fixed, paraffin-embedded specimens were stained with HE and immunohistochemistry to detect the expression of GSTπ, P-gp and LRP. RESULTS: GSTπ was expressed in 39/42 (92.86%) RBs and in 9/9 (100%) well-differentiated RBs. P-gp/GSTπ was found in 30 (71.42%) of 42 RBs. Totally 9 (21.43%) tumors were well differentiated and 33 (78.57%) were poorly differentiated. Totally 15 (35.71%) eyes had optic nerve (ON) tumor invasion, 36 (85.71%) had choroidal tumor invasion, and 14 (33.33%) had simultaneous choroidal and ON invasion. There was no statistically significant relationship between P-gp, GSTπ, LRP positivity and the degree of ocular layer tumor invasion and ON tumor invasion (P>0.05). CONCLUSION: RB intrinsically expresses GSTπ, P-gp and LRP. GSTπ expression is positive in 100% well- differentiation ones, so in which way it is correlated with differentiation. But the other two proteins expressions are not related to tumor differentiation and to the degree of tumor invasion. GSTπ may be a new target of chemotherapy in RB.

7 Pterygial body epithelium domination of pterygial proliferation with TCF4 as a potential key factor

Cong Nie , Xin-Chun Zhang , Si-Ying Xu , Ya-Dan Quan , Zhi-Xin Tang , Rong Lu

2018, 11(9):1467-1474. DOI: 10.18240/ijo.2018.09.07

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Abstract:
AIM: To characterize the proliferative capacity of pterygial epithelium in different regions (head, neck and body) of pterygium and explore the function of transcription factor 4 (TCF4) in pterygium proliferation. METHODS: Thirty pterygium tissues and 10 normal conjunctival tissues were obtained from Zhongshan Ophthalmic Center (ZOC) and Guangdong Eye Bank, respectively. Proliferative capacity of head, neck and body in pterygial epithelium was measured using clonal analysis, fold growth analysis and expression profile of proliferative markers revealed by immunofluorescent staining and real-time PCR. The expression of TCF4 was highlighted by double immunofluorescent staining with other proliferation related markers such as proliferating cell nuclear antigen (PCNA) and ATP-binding cassette sub-family G member 2 (ABCG2). RESULTS: The proliferative potential of pterygial epithelium was higher than that of normal conjunctival epithelium. High expression levels of proliferative markers (P63α, PCNA and ABCG2) in pterygial body epithelium were observed in immunofluorescent staining and real-time PCR (P<0.05). Also, epithelial cells isolated from pterygial body demonstrated higher proliferative capacity in clonal analysis and fold growth analysis, than those isolated from the head and neck regions. The TCF4 expression in pterygial epithelium was similar to other proliferative markers (P63α, PCNA and ABCG2), as higher in pterygial body than head and neck. Moreover, TCF4 showed coexpression with other proliferation-related markers (PCNA and ABCG2) in the double immunofluorescent staining experiment. CONCLUSION: The proliferative capacity in pterygial body epithelium is prominent than the head and neck regions, and upregulated TCF4 may be associated with enhanced proliferation in the pterygium.

8 Establishment of an acute extraocular muscle injury model in cats

Jun-Jie Zhi , Hong Yan , Li-Hua Sun

2018, 11(9):1475-1481. DOI: 10.18240/ijo.2018.09.08

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Abstract:
AIM: To describe an acute extraocular muscle injury model in cats. METHODS: Seventy-two cats were randomly divided into 6 groups (12 cats per group). Cats’ left lateral recti were clamped using a surgical needle holder with a clamping strength of 2 (Groups A and D), 4 (Groups B and E) and 6 kg (Groups C and F). The right lateral recti were treated as controls. On the 4th and 7th days, hematoxylin eosin (HE) staining, immunohistochemical staining for proliferating cell nuclear antigen (PCNA), muscle force measurements and ocular alignment changes were performed to evaluate the extent of injuries. RESULTS: The morphological changes were graded as mild, moderate or severe by HE staining in all experiment groups. PCNA immunohistochemical staining indicated repairment of muscle fibers in the damaged area. On the 4th and 7th days after clamping, the injured lateral muscle exhibited an elevated threshold for electric stimulation. The muscle forces among groups 2, 4 and 6 kg injury at 4d (Groups A, B and C) were statistically significant (P<0.05), but no significant differences were noted among groups 2, 4 and 6 kg injury at 7d (Groups D, E and F) (P>0.05), respectively. In addition, medial deviation in ocular alignment was also present to various degrees in all groups. CONCLUSION: A cat model of acute extraocular muscle injury can be established by rectus clamping. Different clamping strengths can make different degrees of muscle injury. This model may help the future study in the acute extraocular muscle injury.

9 Biomarker identification of thyroid associated ophthalmopathy using microarray data

Hong-Bin Yang , Jie Jiang , Lu-Lu Li , Huang-Qiang Yang , Xiao-Yu Zhang

2018, 11(9):1482-1488. DOI: 10.18240/ijo.2018.09.09

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Abstract:
AIM: To uncover the underlying pathogenesis of thyroid associated ophthalmopathy (TAO) and explore potential biomarkers of this disease. METHODS: The expression profile GSE9340, which was downloaded from Gene Expression Omnibus database, included 18 specimens from 10 TAO patients and 8 hyperthyroidism patients without ophthalmopathy. The platform was HumanRef-8 v2 Expression BeadChip. Raw data were normalized using preprocess. Core package and the differentially expressed genes (DEGs) were identified based on t-test with limma package of R. Functional enrichment analyses were performed recruiting the DAVID tool. Based on STRING database, a protein-protein interaction (PPI) network was constructed, from which a module was extracted. The functional enrichment for genes in the module was performed by the BinGO plugin. RESULTS: In total, 861 DEGs (433 up-regulated and 428 down-regulated) between TAO patients and hyperthyroidism patients without ophthalmopathy were identified. Crucial nodes in the PPI network included TPX2, CDCA5, PRC1, KIF23 and MKI67, which were also remarkable in the module and all enriched in cell cycle process. Additionally, MKI67 was highly correlated with TAO. Besides, the DEGs of GTF2F1, SMC3, USF1 and ZNF263 were predicted as transcription factors (TFs). CONCLUSION: Several crucial genes are identified such as TPX2, CDCA5, PRC1 and KIF23, which all might play significant roles in TAO via the regulation of cell cycle process. Regulatory relationships between TPX2 and CDCA5 as well as between PRC1 and KIF23 may exist. Additionally, MKI67 may be a potent biomarker of TAO, and SMC3 and ZNF263 may exert their roles as TFs in TAO progression.

10 The inflammation influence on corneal surface after frontalis suspension surgery

Kang Li , Xin-Chun Zhang , Xian-Xian Cai , Ya-Dan Quan , Rong Lu

2018, 11(9):1489-1495. DOI: 10.18240/ijo.2018.09.10

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Abstract:
AIM: To study the influence of frontalis muscle flap suspension on ocular surface by analyzing the clinical features and inflammatory cytokines. METHODS: A prospective, observational case series. Thirty-one eyes of 25 patients with severe congenital blepharoptosis who underwent frontalis muscle flap suspension surgery with at least 6mo of follow-up were included in the study. The main outcome measures were margin reflex distance 1 (MRD1), degree of lagophthalmos, ocular surface disease index (OSDI), fluorescein staining (Fl), tear break-up time (BUT), Schirmer I test, and inflammatory cytokine assay. RESULTS: The degrees of lagophthalmos significantly increased after surgery. The OSDI scores significantly increased 1wk postoperatively and then decreased 4wk after operation. The Fl scores reflected corneal epithelial defects in sixteen patients at early stage postoperatively. The BUT and Schirmer I test values remained stable and did not show change compared to those before surgery. The inflammatory cytokines in conjunctival epithelial cells (including IL-1β, IL-6, IL-8, TNF-α, and IL-17A) significantly increased 1wk after the surgery (P<0.001), then returned to the normal level at 24wk postoperatively. The levels of inflammatory cytokine IL-1β, IL-6, IL-8, TNF-α, and IL-17A elevated significantly and were positively correlated with OSDI and Fl scores. CONCLUSION: Frontalis muscle flap suspension surgery results in lagophthalmos in early period of post-operation and relieved after months. The elevation of inflammatory cytokines level may participate in the occurrence of corneal epithelial defects at the early postoperative stage.

11 Lipid layer thickness and tear meniscus height measurements for the differential diagnosis of evaporative dry eye subtypes

Xuan Sang , Yan Li , Liu Yang , Jia-Hui Liu , Xiao-Ran Wang , Chao-Yang Li , Ying Liu , Chen-Jie Wang , Xiong-Jun He , Shou-Bi Wang , Zhi-Chong Wang

2018, 11(9):1496-1502. DOI: 10.18240/ijo.2018.09.11

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Abstract:
AIM: To explore a new diagnostic index for differentiating the evaporative dry eye (EDE) subtypes by analysis of their respective clinical characteristics. METHODS: A cross-sectional study of 139 patients (139 eyes) with EDE who were enrolled and classified as obstructive meibomian gland dysfunction (MGD) (n=81) and non-obstructive MGD (n=58) EDE. All patients completed a Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and were evaluated for average lipid layer thickness (LLT), tear meniscus height measurements (TMH), tear break-up time (TBUT), ocular surface staining score, Schirmer I test (SIT), lid margin abnormalities, and meibomian gland function and morphology. RESULTS: Age, average LLT, TMH, scores of lid margin abnormalities, meibum quality, meibomian gland loss (MGL) (all P≤0.001), and TBUT (P=0.03) were all significantly different between obstructive MGD EDE patients and non-obstructive MGD EDE patients. Average LLT in obstructive MGD EDE was correlated with meibomian expressibility (r= -0.541, P≤0.001), lid margin abnormalities were marginally not significant (r=0.197, P=0.077), and TMH was correlated with MGL (total MGL: r=0.552, P≤0.001; upper MGL: r=0.438, P≤0.001; lower MGL: r=0.407, P≤0.001). Average LLT in non-obstructive MGD EDE, was correlated with meibomian expressibility and Oxford staining (r=-0.396, P=0.002; r=-0.461, P≤0.001). The efficiency of combining average LLT and TMH was optimal, with a sensitivity of 80.2% and a specificity of 74.1%. Obstructive MGD EDE patients had an average LLT≥69 nm and TMH≥0.25 mm, while non-obstructive MGD EDE patients had an average LLT<69 nm and TMH<0.25 mm. CONCLUSION: Obstructive MGD EDE and non-obstructive MGD EDE have significantly different clinical characteristics. Combining average LLT and TMH measurements enhanced their reliability for differentiating these two subtypes and provided guidance for offering more precise treatments for EDE subtypes.

12 Eye reflux: an ocular extraesophageal manifestation of gastric reflux

Danilo Mazzacane , Valerio Damiani , Michela Silvestri , Giorgio Ciprandi , Pierfranco Marino

2018, 11(9):1503-1507. DOI: 10.18240/ijo.2018.09.12

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Abstract:
AIM: To suspect laryngopharyngeal reflux (LPR) in patients with ocular surface disease (OSD). METHODS: The present study evaluated a group of subjects with OSD assessing the Ocular Surface Disease Index (OSDI) and the Reflux Symptom Index (RSI) to detect patients with suspected LPR and define a possible relationship between tests. RESULTS: Two hundred and ninety subjects (175 females, mean age: 60.41±15.68y) were consecutively visited at ophthalmologist offices. One hundred and one (34%) patients had pathological RSI (>13) and consequently a suspected LPR. CONCLUSION: The current study shows that suspected LPR may be common (34%) in patients with OSD and a suspected LPR may be considered in OSD patients when RSI score is >13 and OSDI score is >42.

13 Investigation of possible risk factors in the development of seasonal allergic conjunctivitis

ümit Doğan , Sümeyra Ağca

2018, 11(9):1508-1513. DOI: 10.18240/ijo.2018.09.13

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Abstract:
AIM: To analyze the possible risk factors in the development of seasonal allergic conjunctivitis (SAC) through an evaluation of skin allergy tests and data obtained from questionnaires. METHODS: The study included a total of 75 SAC patients and 71 control subjects without SAC diagnosis who were admitted to the Abant Izzet Baysal University Medical Faculty Ophthalmology Clinic between March 2016 and December 2016. Skin prick tests were performed for all participants. Serum levels of total IgE and 25-OH vitamin D were also measured. In the tear, total IgE levels were measured. Moreover, possible risk factors for the onset of SAC (smoking, paracetamol exposure, vitamin D supplementation and environmental factors etc.) were examined for all patients by both prenatal and postnatal aspects. RESULTS: The patients with SAC were found to have a history of maternal paracetamol exposure during the prenatal period. Likewise, in the same patient group, the duration of postnatal vitamin D supplementation was shorter (P<0.001). However, no significant correlation was found between SAC and maternal antibiotic exposure, maternal smoking, the mode of delivery and birth weight, as well as presence of pets. Moreover, patients with SAC were more likely to have asthma, allergic rhinitis and oral allergy syndrome. We have also found that SAC patients’ mothers and siblings were more likely to have allergic conjunctivitis. Likewise, their fathers were more likely to have allergic rhinitis. CONCLUSION: Prenatal maternal paracetamol exposure and shorter duration of vitamin D supplementation in the postnatal period may play a role in development of SAC. Therefore prevention of unnecessary gestational paracetamol intake and vitamin D supplementation during infancy could potentially reduce the onset and development of SAC.

14 GSTM1-null and GSTT1-active genotypes as risk determinants of primary open angle glaucoma among smokers

Miroslav Stamenkovic , Vesna Lukic , Sonja Suvakov , Tatjana Simic , Ivan Sencanic , Marija Pljesa-Ercegovac , Vesna Jaksic , Sinisa Babovic , Marija Matic , Aleksandra Radosavljevic , Ana Savic-Radojevic , Tatjana Djukic

2018, 11(9):1514-1520. DOI: 10.18240/ijo.2018.09.14

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Abstract:
AIM: To evaluate glutathione transferase theta 1 and mu 1 (GSTT1 and GSTM1) polymorphisms as determinants of primary open angle glaucoma (POAG) risk, independently or in combination with cigarette smoking, hypertension and diabetes mellitus. METHODS: A case-control study with 102 POAG patients and 202 age and gender-matched controls was carried out. Multiplex-polymerase chain reaction method was used for the analysis of GSTM1 and GSTT1 polymorphisms. The differences between two groups were tested by the t-test or χ2 test. Logistic regression analysis was used for assessing the risk for disease development. RESULTS: The presence of GSTM1-null genotype did not contribute independently towards the risk of POAG. However, individuals with GSTT1-active genotype were at almost two-fold increased risk to develop glaucoma (P=0.044) which increased up to 4.36 when combined with GSTM1-null carriers (P=0.024). When glutathione transferase (GST) genotypes were analyzed in association with cigarette smoking, hypertension and diabetes, only carriers of GSTT1-active genotype had significantly increased risk of POAG development in comparison with GSTT1-null genotype individuals with no history of smoking, hypertension and diabetes, respectively (OR=3.52, P=0.003; OR=10.02, P<0.001; OR=4.53, P=0.002). CONCLUSION: The results obtained indicate that both GSTM1-null and GSTT1-active genotypes are associated with increased POAG risk among smokers, suggesting potential gene-environment interaction in glaucoma development.

15 Multimodal imaging in acute retinal ischemia: spectral domain OCT, OCT-angiography and fundus autofluorescence

Nikolaus Feucht , Daniel Zapp , Lukas Reznicek , Chris P. Lohmann , Mathias Maier , Christian S. Mayer

2018, 11(9):1521-1527. DOI: 10.18240/ijo.2018.09.15

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Abstract:
AIM: To describe retinal findings of various imaging modalities in acute retinal ischemia. METHODS: Fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), OCT-angiography (OCT-A) and fundus autofluorescence (FAF) images of 13 patients (mean age 64y, range 28-86y) with acute retinal ischemia were evaluated. Six suffered from branch arterial occlusion, 2 had a central retinal artery occlusion, 2 had a combined arteriovenous occlusions, 1 patient had a retrobulbar arterial compression by an orbital haemangioma and 2 patients showed an ocular ischemic syndrome. RESULTS: All patients showed increased reflectivity and thickening of the ischemic retinal tissue. In 10 out of 13 patients SD-OCT revealed an additional highly reflective band located within or above the outer plexiform layer. Morphological characteristics were a decreasing intensity with distance from the fovea, partially segmental occurrence and manifestation limited in time. OCT-A showed a loss of flow signal in the superficial and deep capillary plexus at the affected areas. Reduced flow signal was detected underneath the regions with retinal edema. FAF showed areas of altered signal intensity at the posterior pole. The regions of decreased FAF signal corresponded to peri-venous regions. CONCLUSION: Multimodal imaging modalities in retinal ischemia yield characteristic findings and valuable diagnostic information. Conventional OCT identifies hyperreflectivity and thickening and a mid-retinal hyperreflective band is frequently observed. OCT-A examination reveals demarcation of the ischemic retinal area on the vascular level. FAF shows decreased fluorescence signal in areas of retinal edema often corresponding to peri-venous regions.

16 Bimodal imaging of proliferative diabetic retinopathy vascular features using swept source optical coherence tomography angiography

Amal M Elbendary , Hossam Youssef Abouelkheir

2018, 11(9):1528-1533. DOI: 10.18240/ijo.2018.09.16

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Abstract:
AIM: To categorize neovessels morphology and to detect response to anti-angiogenic therapy by using structural and angiographic modes of swept source optical coherence tomography (SS-OCT). METHODS: Thirty-two eyes with neovessels at disc (NVD) and neovessels elsewhere (NVE) - as diagnosed by fluorescein angiography- were included. Cross sectional OCT images of disc and macular regions were registered to enface OCT angiography (OCTA), B-scan blood flow over lay and density maps. Three eyes received anti-angiogenic treatment. RESULTS: Pin point registration of cross-sectional OCT and OCTA images differentiated active NVD with vascular elements from fibrous or equivalent fibrovascular elements. En face images delineated NVE as vascular tufts or area of filling while cross-sectional images differentiated NVE from microvascular intraretinal abnormality (IRMA). All cases were associated with enlargement of foveal avascular zone and or areas of capillary non perfusion. Regressed NVD appeared as ghost vessel or pruned vascular loops after injection. CONCLUSION: Structural and angiographic modes of SS-OCT can detect, characterize and categorize the pattern of wide spectrum of neovessels based on blood flow data and density maps. It is potentially useful to detect ischemic changes in the vascular bed and regression of NVD after therapeutic regimens providing substitute for invasive techniques.

17 Comparison of one and three initial monthly intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion

Alper Halil Bayat , Ak&inodot;n Çak&inodot;r , &Scedil;eyma Gülcenur Özturan , Selim Bölükba&scedil;&inodot; , Burak Erden , Mustafa Nuri Elçio&gbreve;lu

2018, 11(9):1534-1538. DOI: 10.18240/ijo.2018.09.17

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Abstract:
AIM: To compare three initial monthly intravitreal ranibizumab (IVR) injections followed by pro re nata (PRN) dosing with one initial monthly IVR injections followed by PRN dosing for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Forty-two eyes of 42 patients who had IVR injections for BRVO were retrospectively studied. Eighteen eyes received 1 initial IVR injection (1+PRN group) and 24 eyes received 3 monthly IVR injections (3+PRN). At 1, 3, 6 and 12mo; spectral-domain optical coherence tomography (SD-OCT) was performed. Central macular thickness (CMT), the integrity of the external limiting membrane (ELM), the presence of subretinal fluid, cyst size, the presence of inner segment/outer segment (IS/OS) defect were determined. RESULTS: At baseline the mean CMT was 521.3±153.2 µm in the 3+PRN group while it was 438.1±162.4 µm in 1+PRN group. At the final visit, mean CMT was 278.3±87.8 µm in the 3+PRN group and 285.2±74.2 µm in the 1+PRN group (P=0.079). The changes in CMT over the entire study period were also comparable in both groups (243±160 µm in the 3+PRN group, and 152.9±175.3 µm in the 1+PRN group; P=0.090). At baseline, best-corrected visual acuity (BCVA) was 0.92±0.60 logarithm of the minimal angle of resolution (logMAR) in the 3+PRN group, while it was 0.72±0.46 logMAR in the 1+PRN group. Final BCVA was 0.42±0.55 logMAR in the 3+PRN group and 0.38±0.50 logMAR in the 1+PRN group (P=0.979). Additionally, the BCVA changes from baseline to final visit were not significantly different (-0.50±0.45 logMAR in the 3+PRN group, and -0.33±0.39 logMAR in the 1+PRN group; P=0.255). CONCLUSION: No significant differences in the anatomical or functional results are found between 3+PRN and 1+PRN regimens in the patients receiving ranibizumab for ME secondary to BRVO. Intact IS/OS and baseline BCVA are good predictor of the visual gain, while baseline CMT is a good predictor of the anatomical gain.

18 A clinicopathological study on IgG4-related ophthalmic disease

Yuka Suimon , Satoru Kase , Kan Ishijima , Hiromi Kanno-Okada , Susumu Ishida

2018, 11(9):1539-1544. DOI: 10.18240/ijo.2018.09.18

[Abstract](1391) [HTML](242) [PDF 822.29 K](591)

Abstract:
AIM: To investigate clinicopathological features of immunoglobulin G4-related ophthalmic disease (IgG4-ROD), and analyze the recurrence rates following systemic corticosteroid administration. METHODS: We retrospectively searched clinical features, laboratory and histological findings based on the medical records of 21 patients with IgG4-ROD. All the patients examined in this study underwent surgical resection in the ocular adnexal lesions and underwent histological evaluation. This study further investigated clinical and histopathological features of 15 patients who received systemic corticosteroid after the resection. RESULTS: The mean age of the patients consisting of 7 males (33%) and 14 females (67%) was 61y. Fourteen patients were diagnosed as definitive, and 2 and 5 patients were probable and possible IgG4-ROD, respectively. Eyelid swelling was an initial symptom in 11 patients (52%) who did not show systemic involvements at a diagnosis. Fifteen patients received systemic corticosteroid administration, and all showed remission of inflammation. Among them, 10 patients did not recur, whereas 5 patients (33%) recurred during tapering. There were no significant difference between patients with or without recurrence in clinicopathological features. CONCLUSION: In this study, female patients are more predominant in IgG4-ROD. While inflammation recurs in one-third of patients, this study do not identify factors associated with recurrence after systemic corticosteroid administration.

19 Trends and characteristics of congenital ectopia lentis in China

Guang-Ming Jin , Min Fan , Qian-Zhong Cao , Jun-Xiong Lin , Yi-Chi Zhang , Jian-Qiang Lin , Yi-Yao Wang , Charlotte-Aimee Young , Dan-Ying Zheng

2018, 11(9):1545-1549. DOI: 10.18240/ijo.2018.09.19

[Abstract](1698) [HTML](243) [PDF 504.16 K](579)

Abstract:
AIM: To elucidate the trends and characteristics of congenital ectopia lentis (CEL) in southern China. METHODS: CEL patients from China admitted to Zhongshan Ophthalmic Center (ZOC) from January 2006 to December 2015 were recruited in our study. Residence, gender, hospitalization time, age at surgery, and the presence of other ocular abnormalities and system disease were statistically analyzed in different subgroups. RESULTS: Four hundred and thirty-seven hospitalizations (306 in-patients) diagnosed with CEL from a total of 283 308 hospitalizations were identified, which accounted for 0.15% of the total in-patients. Of the identified CEL in-patients, the total ratio of boys to girls was 2.22:1. Based on a subgroup analysis according to age, patients aged 12-18 years old constituted the highest proportion (31.70%) of all hospitalized CEL patients, and those 0-3 year old constituted the lowest proportion (8.82%) of the total number. The number of CEL increased from 18 to 72 and the hospital based prevalence increased from 8.60% to 18.10% from 2006 to 2015, and the average age at surgery decreased from 9 years old in 2006 to 7.6 years old in 2015. CONCLUSION: The results reveal upward trends in both the number of CEL hospitalizations and hospital based prevalence of CEL in this 10-year study period, but a reduction in the age at surgery, which may reflect the increase of public awareness of children’s eye care in China.

20 Research progress on the role of connective tissue growth factor in fibrosis of diabetic retinopathy

Teng Ma , Li-Jie Dong , Xue-Li Du , Rui Niu , Bo-Jie Hu

2018, 11(9):1550-1554. DOI: 10.18240/ijo.2018.09.20

[Abstract](1152) [HTML](242) [PDF 311.62 K](568)

Abstract:
Diabetic retinopathy (DR) is one of the most important types of diabetic microangiopathy, which is a specific change of fundus lesions and is one of the most serious complications of diabetes. When DR develops to proliferative DR, the main factors of decreasing vision, and even blindness, include retinal detachment and vitreous hemorrhage caused by contraction of blood vessels by fiber membrane. Recent studies reported that the formation of fiber vascular membrane is closely related to retinal fibrosis. The connective tissue growth factor (CTGF) is a cytokine that is closely related to DR fibrosis. However, its mechanism is poorly understood. This paper summarizes the recent studies about CTGF on DR fibrosis for a comprehensive understanding of the role and mechanism of CTGF in PDR.

21 Application of artificial intelligence in ophthalmology

Xue-Li Du , Wen-Bo Li , Bo-Jie Hu

2018, 11(9):1555-1561. DOI: 10.18240/ijo.2018.09.21

[Abstract](3901) [HTML](240) [PDF 1.55 M](1182)

Abstract:
Artificial intelligence is a general term that means to accomplish a task mainly by a computer, with the least human beings participation, and it is widely accepted as the invention of robots. With the development of this new technology, artificial intelligence has been one of the most influential information technology revolutions. We searched these English-language studies relative to ophthalmology published on PubMed and Springer databases. The application of artificial intelligence in ophthalmology mainly concentrates on the diseases with a high incidence, such as diabetic retinopathy, age-related macular degeneration, glaucoma, retinopathy of prematurity, age-related or congenital cataract and few with retinal vein occlusion. According to the above studies, we conclude that the sensitivity of detection and accuracy for proliferative diabetic retinopathy ranged from 75% to 91.7%, for non-proliferative diabetic retinopathy ranged from 75% to 94.7%, for age-related macular degeneration it ranged from 75% to 100%, for retinopathy of prematurity ranged over 95%, for retinal vein occlusion just one study reported ranged over 97%, for glaucoma ranged 63.7% to 93.1%, and for cataract it achieved a more than 70% similarity against clinical grading.

22 A novel NF1 frame-shift mutation c.703_704delTA in a Chinese pedigree with neurofibromatosis type 1

Jun Chen , Bo Guo , Min Ren , Hong Lin , Xin Zhang , Si-Yi Chen , Xiao-Tian Yu , Zhu-Ping Xu

2018, 11(9):1562-1565. DOI: 10.18240/ijo.2018.09.22

[Abstract](1487) [HTML](247) [PDF 1.70 M](665)

Abstract:
We analyzed the clinical features and NF1 gene mutation in a Chinese pedigree of neurofibromatosis type 1 (NF1). Three members of this family were NF1 patients presenting with different clinical phenotypes and the others were asymptomatic. Exons of NF1 were amplified by polymerase chain reaction, sequenced, compared with a reference database. One novel NF1 frame-shift mutation c.703_704delTA, which resulted in a premature stop signal at codon 720 and the synthesis of truncated, was revealed. This mutation segregated with the NF1 members is likely responsible for the pathogenesis of NF1 in the family.

23 Retinal detachment in a boy with Gaucher disease

Tan-Tai Zhao , Hui-Ling Li , Xiao-Jian Guo , Jing Luo , Xiao Liu , Fang Fang

2018, 11(9):1566-1568. DOI: 10.18240/ijo.2018.09.23

[Abstract](1057) [HTML](231) [PDF 956.48 K](566)

Abstract:

24 Chronic ocular GVHD: limbal and conjunctival stem cell allografts from the same hematopoietic stem cell donor

Elias F Jarade , Hala El Rami , Youssef Abdelmassih , Mazen Amro

2018, 11(9):1569-1572. DOI: 10.18240/ijo.2018.09.24

[Abstract](940) [HTML](238) [PDF 1.05 M](550)

Abstract:

25 Ocular syphilis: resurgence of an old disease in modern Malaysian society

Mushawiahti Mustapha , Zakaria Abdollah , Amin Ahem , Hazlita Mohd Isa , Mae-Lynn Catherine Bastion , Norshamsiah Md Din

2018, 11(9):1573-1576. DOI: 10.18240/ijo.2018.09.25

[Abstract](1132) [HTML](235) [PDF 659.93 K](567)

Abstract:

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Volume 11,Issue 9,2018 Table of Contents