Volume 12,Issue 10,2019 Table of Contents

1 Celastrol inhibits migration, proliferation and transforming growth factor-β2-induced epithelial-mesenchymal transition in lens epithelial cells

Li-Ping Wang , Bao-Xin Chen , Yan Sun , Jie-Ping Chen , Shan Huang , Yi-Zhi Liu

2019, 12(10):1517-1523. DOI: 10.18240/ijo.2019.10.01

[Abstract](1499) [HTML](260) [PDF 1.94 M](707)

Abstract:
AIM: To investigate the mechanism of celastrol in inhibiting lens epithelial cells (LECs) fibrosis, which is the pathological basis of cataract. METHODS: Human LEC line SRA01/04 was treated with celastrol and transforming growth factor-β2 (TGF-β2). Wound-healing assay, proliferation assay, flow cytometry, real-time polymerase chain reaction (PCR), Western blot and immunocytochemical staining were used to detect the pathological changes of celastrol on LECs. Then, we cultured Sprague-Dawley rat lens in medium as a semi-in vivo model to find the function of celastrol further. RESULTS: We found that celastrol inhibited the migration of LECs, as well as proliferation (P<0.05). In addition, it induced the G2/M phase arrest by cell cycle-related proteins (P<0.01). Moreover, celastrol inhibited epithelial-mesenchymal transition (EMT) by the blockade of TGF-β/Smad and Jagged/Notch signaling pathways. CONCLUSION: Our study demonstrates that celastrol could inhibit TGF-β2-induced lens fibrosis and raises the possibility that celastrol could be a potential novel drug in prevention and treatment of fibrotic cataract.

2 Gatifloxacin inducing apoptosis of stromal fibroblasts through cross-talk between caspase-dependent extrinsic and intrinsic pathways

Bin Xu , Yun-Long Sui , Ting-Jun Fan

2019, 12(10):1524-1530. DOI: 10.18240/ijo.2019.10.02

[Abstract](1088) [HTML](250) [PDF 1.33 M](616)

Abstract:
AIM: To reveal the cytotoxicity and related mechanisms of gatifloxacin (GFX) to stromal fibroblasts (SFs) in vitro. METHODS: SFs were treated with GFX at different concentrations (0.009375%-0.3%), and their viability was detected by MTT method. The cell morphology was observed using light/transmission electron microscope. The plasma membrane permeability was measured by AO/EB double-staining. Then cell cycle, phosphatidylserine (PS) externalization, and mitochondrial transmembrane potential (MTP) were analyzed by flow cytometry. DNA damage was analyzed by electrophoresis and immunostaining. ELISA was used to evaluate the caspase-3/-8/-9 activation. Finally, Western blotting was applied for detecting the expressions of apoptosis-related proteins. RESULTS: Morphological changes and reduced viability of GFX-treated SFs demonstrated that GFX above 0.009375% had cytotoxicity to SFs with dependence of concentration and time. GFX-treating cells also showed G1 phase arrest, increased membrane permeability, PS externalization and DNA damage, which indicated that GFX induced apoptosis of SFs. Additionally, GFX could activate the caspase-8, caspase-9, and caspase-3, induce MTP disruption, downregulate B-cell leukemia-2 (Bcl-2) and B-cell leukemia-XL (Bcl-XL), and upregulate Bcl-2 assaciated X protein (Bax), Bcl-2-associated death promoter (Bad), Bcl-2 interacting domain (Bid) and cytoplasmic cytochrome C in SFs, suggesting that caspase-dependent extrinsic and intrinsic pathways were related to GFX-contributed apoptosis of SFs. CONCLUSION: The cytotoxicity of GFX induces apoptosis of SFs through triggering the caspase-dependent extrinsic and intrinsic pathways.

3 Parthenolide inhibits the proliferation and induces the apoptosis of human uveal melanoma cells

Song-Tian Che , Li Bie , Xu Li , Hui Qi , Peng Yu , Ling Zuo

2019, 12(10):1531-1538. DOI: 10.18240/ijo.2019.10.03

[Abstract](1458) [HTML](255) [PDF 3.02 M](640)

Abstract:
AIM: To explore the effect of parthenolide (PTL) on human uveal melanoma (UM) cells (C918 and SP6.5 cells) and its molecular mechanism. METHODS: Carboxyfluorescein succinimidyl amino ester (CFSE) assays and cell counting kit-8 (CCK-8) were performed to detect the cell viability. Flow cytometry was used to analyze cell cycle and apoptosis. Quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot assays were performed to measure proliferation-related and apoptosis-related factors. RESULTS: Firstly, PTL decreased the viability of C918 and SP6.5 cells in a dose-dependent manner, and the effect of PTL on C918 cells was stronger than on SP6.5; however, it did not affect normal cells. Secondly, PTL increased the proportion of cell number at cell cycle G1 phase in C918 cells, and decreased the proportion of cell number at S phase, but the proportion did not change at G2 phase. In addition, PTL induced the apoptosis of C918 cells, and decreased the expressions of Cyclin D1, B-cell lymphoma-2 (Bcl-2) and B-cell lymphoma-extra large (Bcl-XL). Also, PTL increased Cyclin inhibition protein 1 (P21), Bcl-2-associated X protein (Bax), Cysteinyl aspartate specific proteinas-3 (Caspase-3) and Caspase-9 expression. However, the expression of Caspase-8 was not changed. CONCLUSION: PTL inhibites proliferation and induces apoptosis in UM cells by arresting G1 phase and regulating mitochondrial pathway, however, it does not affect normal cells.

4 Inhibition of Obtusifolin on retinal pigment epithelial cell growth under hypoxia

Li-Fei Wang , Zhong-Yang Yan , Ya-Lin Li , Yan-Hui Wang , Sheng-Juan Zhang , Xin Jia , Lu Lu , Yan-Xia Shang , Xin Wang , Yun-Huan Li , Shan-Yu Li

2019, 12(10):1539-1547. DOI: 10.18240/ijo.2019.10.04

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Abstract:
AIM: To explore the effect of Obtusifolin on retinal pigment epithelial cell growth under hypoxia. METHODS: In vitro chemical hypoxia model of ARPE-19 cells was established using cobalt chloride (CoCl2). Cell viability was tested by cell counting kit-8 (CCK-8) assay. Western blot and real-time quantitative polymerase chain reaction were applied to detect proteins and mRNAs respectively. Flow cytometry was used to examine the cell cycle. Secretion of vascular endothelial growth factor (VEGF) was tested by using enzyme linked immunosorbent assay (ELISA). RESULTS: Under the chemical hypoxia model established by CoCl2, hypoxia inducible factor-1α (HIF-1α) mRNA and protein levels was up-regulated. Cell viability was increased and the proportion of S phase was higher. Obtusifolin could reduce cell viability under hypoxic conditions and arrest cells in G1 phase. Obtusifolin reduced the expression of Cyclin D1 and proliferating cell nuclear antigen (PCNA) in the hypoxic environment and increased the expression of p53 and p21. The levels of VEGF, VEGFR2 and eNOS proteins and mRNA were significantly increased under hypoxia while Obtusifolin inhibited the increasing. CONCLUSION: Obtusifolin can inhibit cell growth under hypoxic conditions and down-regulate HIF-1/VEGF/eNOS secretions in ARPE-19 cells.

5 Comparison of ocular parameters of two biometric measurement devices in highly myopic eyes

Xiao-Xiao Guo , Ran You , Shan-Shan Li , Xiu-Fen Yang , Lu Zhao , Fan Zhang , Yan-Ling Wang , Xi Chen

2019, 12(10):1548-1554. DOI: 10.18240/ijo.2019.10.05

[Abstract](1281) [HTML](260) [PDF 2.10 M](651)

Abstract:
AIM: To compare the differences and agreement of ocular biometric parameters in highly myopic eyes obtained by optical biometric measurement instruments, the OA-2000 and IOLMaster 500. METHODS: Totally, 90 patients (90 eyes) were included. They were divided into high myopia group and control group. Ocular parameters, including axial length (AL), mean keratometry (Km), anterior chamber depth (ACD), and white to white (WTW), were obtained from the OA-2000 and IOLMaster 500. RESULTS: For the control group, we applied Bland-Altman graphs to assess the 95% limits of agreement (LoA) for most parameters including AL, ACD, Km, and WTW (-0.24 to 0.29 mm, -0.22 to 0.45 mm, -0.39 to 0.31 D, and -0.90 to 0.86 mm, respectively). In high myopia patients, AL, ACD, Km values had wider 95% LoA (-0.34 to 0.32 mm, -0.36 to 0.34 mm, -0.57 to 0.47 D, respectively), except WTW (-0.80 to 0.68 mm). Differences were not statistically significant between these two instruments (P>0.05). CONCLUSION: Most parameters obtained by the OA-2000 and IOLMaster 500 are comparable, including the AL, ACD, and K values. Among them, the agreement of the high myopia patients is poor compared to the patients without high myopia.

6 Changes of tear film lipid layer thickness by 3% diquafosol ophthalmic solutions in patients with dry eye syndrome

Dong-Hyun Kang , Yong-Woo Lee , Kyu-Yeon Hwang , Kyung-Min Koh , Young-A Kwon , Byung-Yeop Kim , Sang-Wroul Song , Kook-Young Kim

2019, 12(10):1555-1560. DOI: 10.18240/ijo.2019.10.06

[Abstract](1447) [HTML](249) [PDF 1.09 M](749)

Abstract:
AIM: To evaluate the quantitatively changes in lipid layer thickness (LLT) when 3% diquafosol eye drop is used for dry eye patients using the tear film interferometer. METHODS: A total 124 participants (32 males, 92 females; mean age, 28.9y) diagnosed with dry eye disease (DED) received topical instillation of 4 ophthalmic solutions in one eye: diquafosol, normal saline, 0.1% sodium hyaluronate and 0.3% gatifloxacin, in a masked manner. LLT was measured using an interferometer at baseline and 20min after the instillation of each ophthalmic solutions. RESULTS: Changes of LLT after instillation (nm, mean± standard error) were as follows: 12.6±2.0 for diquafosol (P<0.001), 1.2±2.2 for normal saline (P=0.301), 1.5±2.0 for hyaluronate (P=0.495), and 0.5±3.2 for gatifloxacin (P=0.884). CONCLUSION: Topical instillation of diquafosol increases tear film LLT in DED patients. Diquafosol 3% eye drop might be effective treatment option of evaporative DED with meibomian gland dysfunction.

7 Accuracy of corneal astigmatism correction with two Barrett Toric calculation methods

Jun Yang , Hong Zhang , Xiao-Tong Yang , Fang Tian , Shao-Zhen Zhao

2019, 12(10):1561-1566. DOI: 10.18240/ijo.2019.10.07

[Abstract](1299) [HTML](250) [PDF 1.11 M](665)

Abstract:
AIM: To compare the prediction error between Barrett Toric calculator and the new online AcrySof Toric calculator which incorporated Barrett astigmatism algorithm in Chinese cataract eyes with normal axial length and anterior chamber depth (ACD). METHODS: Prospective case-control study. All the cases had axial length (21-26 mm) with ACD no less than 2.4 mm. Keratometric values were measured by LenSTAR 900. The Barrett Toric calculator was used in group 1. In group 2, SRK-T formula was used to determine the spherical power of the Toric lens, and subsequent calculation of the cylinder type was performed using the new online Alcon Toric calculator. At 1 and 3mo after surgery, a comprehensive subjective optometry was performed. The predicted residual astigmatism calculated by the two calculators was compared with that obtained by postoperative refraction, and the difference was defined as the astigmatism correction error [error of refractive astigmatism (ERA)]. The error magnitude (EM) refers to the algebraic deviation of ERA, and the error vector (EV) indicates the vector deviation of ERA. The influence of the two calculation methods on the correction accuracy of toric IOL was quantitatively analyzed. RESULTS: The |EM| obtained at 1mo after surgery were 0.21±0.12 D, 0.22±0.18 D in group 1 and group 2 respectively, and correspondingly turned to be 0.19±0.13 D, 0.20±0.19 D at 3mo after surgery, with no statistical difference (P=0.633, P=0.877). The vector analysis showed that |EV| values in two groups at 1mo after surgery were 0.29±0.14@105 (D@angle) and 0.35±0.20@113 (D@angle), respectively, whereas |EV| values 3mo after surgery were 0.27±0.16@86 (D@angle) and 0.32±0.23@102 (D@angle), respectively. The differences between the groups were not statistically significant (P=0.119, P=0.261). CONCLUSION: The clinical effect of Barrett Toric calculator has a much more accurate tendency than that of new online AcrySof Toric calculator, but is not evident in cases with normal axial length and normal anterior posterior ratio.

8 Postoperative adjunctive bevacizumab versus placebo in primary trabeculectomy surgery for glaucoma

Sana’ Muhsen , Javiera Compan , Tze Lai , Christoph Kranemann , Catherine Birt

2019, 12(10):1567-1574. DOI: 10.18240/ijo.2019.10.08

[Abstract](1036) [HTML](269) [PDF 407.98 K](631)

Abstract:
AIM: To compare the effectiveness of postoperative adjunctive use of subconjunctival bevacizumab in altering the outcome of primary trabeculectomy in terms of sustained lowering of intraocular pressure (IOP) and reduction of postoperative bleb vascularization and fibrosis. METHODS: A prospective, one center, randomized, placebo-control study. Fifty-nine patients (59 eyes) with uncontrolled IOP under maximal tolerated medical treatment (MTMT) were recruited. A primary trabeculectomy with mitomycin C (MMC) was done and the patients were randomized to either postoperative subconjunctival injection of bevacizumab (1.25 mg/0.05 mL) or balanced salt solution (BSS). Forty-seven patients (47 eyes) completed at least one year of follow up and were included in the study. The main outcome measure was the IOP, and secondary outcome measures include bleb morphology, vascularization, and fibrosis, as well as the need for glaucoma medications and 5-fluorouracil (5-FU) needling. RESULTS: At 1-year follow up, there was no significant difference between groups for IOP (P=0.65), bleb morphology (P=0.65), and the need for glaucoma medications (P=0.65) or 5-FU needling requirements (P=0.11). However, the bevacizumab group had a higher rate of success results, lower use of glaucoma medications after surgery, and optimal bleb aspect in more patients, but more 5-FU needling procedures required. CONCLUSION: A bigger sample size is needed in order to determine whether the differences found in the bevacizumab group are statistically significant.

9 Early outcomes of vision and objective visual quality analysis after cataract surgery with trifocal intraocular lens implantation

Mei-Fang Chu , Na Hui , Cong-Yi Wang , Lei Yu , Bo Ma , Yan Li , Cheng Pei

2019, 12(10):1575-1581. DOI: 10.18240/ijo.2019.10.09

[Abstract](1082) [HTML](247) [PDF 807.54 K](616)

Abstract:
AIM: To investigate the early outcomes of vision, objective visual quality and their correlation after cataract surgery with trifocal intraocular lens implantation. METHODS: The visual examination and objective visual quality analysis using Optical Quality Analysis System (OQAS) at 1mo and 3mo, and defocus curve examination at 3mo were performed in 20 patients (27 eyes) after phacoemulsification combined with trifocal intraocular lens implantation surgery. RESULTS: The uncorrected distant (UD), intermediate and near visual acuity (VA) were significantly improved after surgery (P<0.001). UDVA at 1mo after the surgery was slightly better than that after 3mo (P=0.026). The defocus curve after 3mo indicated that the peak of distant vision was close to 0 logMAR, and UDVA was lower than 0.3 logMAR in the range of -1.5 D to -3.0 D. The modulation transfer function (MTF) cutoff frequency, strehl ratio (SR), Optical Quality Analysis System values (OVs), includes OV100, OV20 and OV9 after the surgery were significantly better than before surgery (P<0.001), but the objective scattering index (OSI) was significantly decreased (P<0.001). UDVA at 3mo after the surgery had correlations with MTF cutoff, OSI, OV100 and OV20 (r=-0.400, 0.431, -0.437, -0.411, P=0.039, 0.025, 0.023, 0.033). The uncorrected intermediate VA after 3mo of the surgery had correlations with OSI and OV100 (r=0.478, -0.411, P=0.012, 0.033). CONCLUSION: Trifocal intraocular lens implantation can provide good distant, intermediate and near VA, and the vision shows a well correlation with objective visual quality during early surgery.

10 Incomplete fluid-air exchange technique for idiopathic macular hole surgery

Bo-Jie Hu , Xue-Li Du , Wen-Bo Li , Yu-Wen Chang , Xing-Dong Shi , Teng Ma , Yong Wang , Yan-Hua He , Rui Niu , Wei-Na Cui

2019, 12(10):1582-1588. DOI: 10.18240/ijo.2019.10.10

[Abstract](958) [HTML](272) [PDF 818.18 K](642)

Abstract:
AIM: To explore an improved procedure involving incomplete fluid-air exchange for idiopathic macular hole (IMH), and the closure rate, visual function, and the visual field of macular holes (MHs) were evaluated. METHODS: This prospective randomized controlled study, included 40 eyes of 40 patients with IMH who were treated with pars plana vitrectomy and peeling of the internal limiting membrane. They were grouped by random digital table. Twenty-one eyes underwent incomplete fluid-air exchange (IFA) and 19 eyes underwent traditional complete fluid-air exchange (CFA) as the control group. Outcomes included best-corrected visual acuity (BCVA), intraocular pressure, and optical coherence tomography, light adaptive electroretinography, and visual field evaluations. RESULTS: All MHs <400 μm were successfully closed. BCVAs before and 6mo after surgery were 0.82±0.41 logMAR and 0.28±0.17 logMAR in IFA group and 0.86±0.34 logMAR and 0.34±0.23 logMAR in CFA group, respectively. The electroretinogram analysis of patients in IFA group revealed increases in b-wave amplitudes at 1, 3, and 6mo after surgery. Additionally, patients in IFA group showed an amplitude increase of 28.6% from baseline at 6mo (P<0.05), while no obvious improvements were noted in CFA group. Although there were no statistically significant improvements in either group, the IFA group showed a slight increase in mean sensitivity (P>0.05). CONCLUSION: IFA is a reliable method that offers comparable closure rate to CFA and facilitates improvements in visual function.

11 Anatomical and functional changes after dexamethasone implant and ranibizumab in diabetic macular edema: a retrospective cohort study

Leonardo Mastropasqua , Silvio Di Staso , Rossella D’Aloisio , Alessandra Mastropasqua , Luca Di Antonio , Alfonso Senatore , Marco Ciancaglini , Marta Di Nicola , Giuseppe Di Martino , Daniele Tognetto , Lisa Toto

2019, 12(10):1589-1597. DOI: 10.18240/ijo.2019.10.11

[Abstract](1445) [HTML](252) [PDF 2.11 M](674)

Abstract:
AIM: To investigate the efficacy and safety of ranibizumab (RZB group) and dexamethasone implant (DEX group) intravitreal treatments in patients with treatment-naïve center involved diabetic macular edema (DME) by means of functional and morphological assessments. METHODS: This retrospective cohort study included 50 eyes of 50 patients with DME treated either with RBZ or DEX. Best-corrected visual acuity (BCVA) and microperimetry were evaluated at baseline and during a 6-month follow-up. In addition, central macular thickness (CMT) by means of structural optical coherence tomography (OCT) and retinal capillary plexus density and choriocapillary density by means of OCT angiography were assessed in all cases. RESULTS: Functional and morphological parameters significantly improved during the study period in both groups. BCVA improved significantly in both groups with a greater increase in the DEX group compared to the RBZ group (P=0.030). Microperimetry significantly differed during follow-up between the two treatments (P=0.031). In both groups CMT significantly decreased (P<0.001) without statistically significant differences between the two groups. A statistically significant increase of deep capillary plexus density was detected in both groups at 30d after therapy. The retreatment rate was 0.70±0.10 and 0.65±0.10 in the RBZ group and 0.65±0.10 and 0.50±0.11 in DEX group at 120 and 180d respectively. Two out of 25 patients in DEX group showed intraocular pressure increase requiring hypotonic eye drops. CONCLUSION: Both treatments are very effective for DME treatment during 6mo of follow-up with a lower retreatment rate in DEX group.

12 Association of urinary albumin excretion with central foveal thickness and intravitreal conbercept treatment frequency in patients with diabetic macular edema

Zi-Yao Liu , Xiao-Jie Ma , Ding-Ying Liao , Xin-Di Liu , Ling Bai , Jing Yao , Min Xu , Yu-Ping Zheng

2019, 12(10):1598-1604. DOI: 10.18240/ijo.2019.10.12

[Abstract](1431) [HTML](243) [PDF 486.24 K](633)

Abstract:
AIM: To investigate the effect of albuminuria on diabetic macular edema (DME) and the possible association between baseline urinary albumin excretion (UAE) and intravitreal conbercept (IVC) treatment frequency in DME patients. METHODS: In this hospital-based retrospective study, a total of 350 in-patients with type 2 diabetes mellitus were recruited and their clinical records were reviewed. Thereafter, 52 patients identified with severe non-proliferative diabetic retinopathy (NPDR) combined with albuminuria were divided into the microalbuminuria (UAE 30-300 mg/24h) and macroalbuminuria (UAE>300 mg/24h) groups, which were compared and analyzed by both independent sample t-test and Chi-square test. Correlations between the systemic variables and the central foveal thickness (CFT) were evaluated using Spearman’s correlation and linear regression analyses. Of the 52 patients with center-involved DME, 43 received an initial combined injection of conbercept (0.5 mg/0.05 mL) and triamcinolone acetonide (1 mg/0.05 mL), followed by an IVC injection, as needed. The relationship between baseline UAE and number of IVC injections during the first year of treatment was analyzed using Spearman’s partial correlation. RESULTS: Of 350 patients, a higher incidence of DME was observed in severe non-proliferative retinopathy (NPDR) patients than that observed in other groups. By dividing the 52 patients with severe NPDR into the micro- and macro-albuminuria subgroups, significant differences in CFT, systolic blood pressure, total cholesterol and serum creatinine levels, and UAE were revealed. Furthermore, a positive liner correlation between the UAE and CFT was found. Finally, the partial correlation coefficient adjusted for either the CFT or UAE indicated that both parameters directly correlated with the number of IVC injections administered during the 12mo of follow-up. CONCLUSION: Generally, macular edema occurred in patients with severe NPDR, for whom the UAE is an independent risk predictor of DME. The baseline UAE and CFT predicted the treatment frequency of IVC injections administered in the first year for eyes with DME.

13 Association between interleukin-10 genetic polymorphisms and risk of primary open angle glaucoma in a Chinese Han population: a case-control study

Yi-Hui Zhang , Yi-Qiao Xing , Zhen Chen , Xiao-Cheng Ma , Qiang Lu

2019, 12(10):1605-1611. DOI: 10.18240/ijo.2019.10.13

[Abstract](1316) [HTML](254) [PDF 502.80 K](617)

Abstract:
AIM: To investigate the association between interleukin-10 (IL-10) genetic polymorphisms and risk of POAG through a case-control study in a Han population of China. METHODS: A total of 210 patients with POAG and 420 normal subjects were recruited during the period from Dec. 2013 to Dec. 2016. The IL-10 -1082A>G (rs1800870), -819T>C (rs1800871) and -592C>A (rs1800872) polymorphisms were determined using iPlex GOLD SNP genotyping analysis (the SequenomMassARRAY® System, Sequenom, San Diego, USA). The association between IL-10 -1082A>G (rs1800870), -819T>C (rs1800871), and -592C>A (rs1800872) polymorphisms and risk of POAG was assessed by singlelogistic regression analysis. RESULTS: We observed that those carrying the CC genotype of rs1800871 was associated with an increased risk of POAG when compared with those harboring the TT genotype (OR=1.84, 95%CI=1.01-3.38). Those with AA genotype of rs1800872 had a 10.62 fold risk of POAG in comparison to the CC genotype (OR=10.62, 95%CI, 3.41-33.09). A completely linkage disequilibrium was found between IL-10 rs1800871-rs1800872 (D’=1.00, r2=0.16). The A-C-A (OR=2.60, 95%CI, 1.48-4.58) and G-T-A (OR=2.34, 95%CI, 1.42-3.86) haplotypes were associated with an increased risk of POAG, while the A-T-C haplotype showed a decreased risk of POAG (OR=0.63, 95%CI, 0.49-0.81). CONCLUSION: Our data suggest that IL-10 rs1800871 and rs1800872 can be predictive factors for the pathogenesis of POAG in the Chinese population.

14 Prevalence of visual impairment and refractive errors in an urban area of Mexico

Isabel Signes-Soler , David P Piñero , Milagro Inés Murillo , Silvia Tablada

2019, 12(10):1612-1617. DOI: 10.18240/ijo.2019.10.14

[Abstract](1264) [HTML](252) [PDF 375.04 K](654)

Abstract:
AIM: To determine the distribution of refractive errors in a school-age population in Quintana Roo (Mexico) in the framework of an international cooperation campaign for the prevention of blindness. METHODS: A sample of 2647 school-age children (ranging from 5 to 14 years old) with a mean age of 9.1±1.9 years old were tested by trained volunteers for distance visual acuity (VA) and refractive errors. The first screening examination included uncorrected distance visual acuity (UDVA) and VA with a +2.00 D lens. Inclusion criteria for a second complete cycloplegic eye examination performed by an optometrist were UDVA <20/25 (0.10 logMAR or 0.8 decimal) and/or VA with +2.00 D ≥20/25. RESULTS: A total of 633 (23.9%) children underwent the second complete eye examination. Mean logMAR UDVA was 0.035±0.094 (range 1.00 to 0.00 logMAR) for the right eyes and 0.036±0.160 (range 1.00 to 0.00 logMAR) for the left eyes. Bilateral amblyopia was found in 17 children (2.7% of refracted eyes; 0.64% of the total). The main reason for visual impairment (VI) in the sample analyzed was found to be refractive errors. In 12 children (1.9% of refracted eyes; 0.45% of the total) the VI was bilateral and 9 (1.4% of refracted eyes; 0.34% of the total) achieved a corrected distance visual acuity of 20/25 or better in both eyes. Mean magnitude of sphere and refractive cylinder was +0.20±0.96 D and -0.43±0.85 D in right eyes, and +0.24±1.08 and -0.43±0.83 D in left eyes. The proportion of myopic eyes [standard equivalent (SE) ≤-0.50 D] was 4.6% of the whole sample (5290 eyes). The mean magnitude of myopia was -0.84±3.44 D for the right eyes and -0.82±5.21 D for the left eyes. The proportion of hyperopic patients (SE≥+2.00 D) was 2.4% (15/633), which corresponded to 0.60% of the whole sample (32/5290 eyes). No statistically significant correlation of age to manifest sphere or cylinder was found. CONCLUSION: VI due to uncorrected refractive errors can be easily corrected with glasses but it is still a burden to be treated. Myopia is prevalent in this sample. More efforts towards correcting uncorrected refractive errors are needed.

15 New approaches for diagnosis of dry eye disease

Abdelrahman M. Elhusseiny , Ali A. Khalil , Reem H. El Sheikh , Mohammad A. Bakr , Mohamed Gaber Eissa , Yasmine M. El Sayed

2019, 12(10):1618-1628. DOI: 10.18240/ijo.2019.10.15

[Abstract](2957) [HTML](256) [PDF 370.14 K](778)

Abstract:
We reviewed the literature for different diagnostic approaches for dry eye disease (DED) including the most recent advances, contradictions and promising diagnostic tools and technique. We performed a broad literature search for articles discussing different methods for diagnosis of DED including assessment of tear osmolarity, tear film stability, ocular biomarkers and others. Articles indexed in PubMed and google scholar were included. With the growing cosmetic industry, environmental pollution, and booming of digital screens, DED is becoming more prevalent. Its multifactorial etiology renders the diagnosis challenging and invites the emergence of new diagnostic tools and tests. Diagnostic tools can be classified, based on the parameter they measure, into tear film osmolarity, functional visual acuity, tear volume, tear turnover, tear film stability, tear film composition, ocular biomarkers and others. Although numerous methods exist, the most accurate diagnosis can be reached through combining the results of more than one test. Many reported tests have shown potential as diagnostic/screening tools, however, require more research to prove their diagnostic power, alone or in combination. Future research should focus on identifying and measuring parameters that are the most specific to DED diagnosis.

16 Progression on canaloplasty for primary open angle glaucoma

Jun Zhang , Ning-Li Wang

2019, 12(10):1629-1633. DOI: 10.18240/ijo.2019.10.16

[Abstract](1391) [HTML](243) [PDF 335.28 K](639)

Abstract:
As a non-penetrating glaucoma surgery (NPGS), canaloplasty aims to reconstruct the physiological outflow of aqueous humor by dilating the Schlemm’s canal. Ab interno canaloplasty (ABiC), which can reconstruct the natural outflow pathways of aqueous humor in mild-to-moderate primary open angle glaucoma (POAG) patients, is a new minimally invasive glaucoma surgery (MIGS) procedure improving from traditional canaloplasty. Canaloplasty can reduce intraocular pressure (IOP) with high efficiency and security. There are no complications such as scar formation and encapsulation for this no-bleb canaloplasty.

17 Correlation between obstructive sleep apnea and central retinal vein occlusion

Yan-Hui Wang , Peng Zhang , Lian Chen , Zhao Jiang , Lu-Xi Li , Ke He , Xiao-Qing Li

2019, 12(10):1634-1636. DOI: 10.18240/ijo.2019.10.17

[Abstract](1310) [HTML](244) [PDF 321.52 K](659)

Abstract:
To investigate the possible correlation between obstructive sleep apnea (OSA) and central retinal vein occlusion (CRVO). Thirty consecutive patients with a recent (<3mo) CRVO and an age- and sex-matched group of 30 control subjects were recruited. All subjects underwent full-night polysomnography to measure apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). The average AHI and ODI were significantly higher in CRVO patients (AHI: 13.86±8.63, ODI: 9.21±4.47) than in control subjects (AHI: 8.51±6.36, ODI: 5.87±3.18; P=0.008 and 0.001 respectively). Additionally, the AHI was positively correlated with body mass index (BMI; r=0.476, P=0.017) and ODI (r=0.921, P<0.01) in both CRVO and control subjects. According to AHI scores, twenty-two (73.33%) CRVO patients had OSA and 12 (40.00%) control subjects had OSA, a difference that was statistically significant (P=0.019). OSA may be a risk factor for or a trigger of CRVO development.

18 Effects of 0.4% ripasudil hydrochloride hydrate on morphological changes in rabbit eyes

Bundit Limratchatamorn , Ken Asakawa , Kimiyo Mashimo , Shigekazu Uga , Hitoshi Ishikawa

2019, 12(10):1637-1642. DOI: 10.18240/ijo.2019.10.18

[Abstract](1068) [HTML](269) [PDF 2.09 M](671)

Abstract:
We evaluated the cellular structure changes after continuous use of ripasudil hydrochloride hydrate in rabbit eyes which might affect its own efficacy and adverse effects. Two pigmented Dutch rabbits and 1 Japanese white rabbit were instilled with 0.4% ripasudil hydrochloride hydrate to the left eye twice daily. The right eye was observed as the control. Both eyes of all 3 rabbits were then enucleated for histopathologic examination by light and electron microscope at 1mo in 1 of the pigmented Dutch rabbits, 3mo in the other pigmented Dutch rabbit, and in the Japanese white rabbit after instillation. Microscopic observations showed increase intercellular space in trabecular meshwork, ciliary body, and iris stoma, increase pigmented granule number and size in iris epithelial cells, and decrease actin filament in iris muscle fiber cells. Consequently, ripasudil hydrochloride hydrate decreases the intraocular pressure by improving the conventional outflow and may also facilitate the unconventional outflow via intercellular space widening without serious side effects.

19 Functional outcome of the low vision aids for visual impairment secondary to central nervous system tumors in children

Rania GE Zaki , Reham F. Elshinawy , Karim M. Naguib

2019, 12(10):1643-1648. DOI: 10.18240/ijo.2019.10.19

[Abstract](1134) [HTML](243) [PDF 372.89 K](584)

Abstract:
To assess functional outcomes of optical low vision aids (LVAs) for pediatric visual impairment due to central nervous system (CNS) tumors. A prospective case study was conducted on 15 children with history of CNS tumors with mean age of 10.47±1.85y. Lighthouse distance, near visual acuity tests, cycloplegic refraction, reading speed measurement and visual field examination were done. Prescription of far and near LVAs followed by training sessions. LVPrasad-functional vision questionnaire was done to evaluate performance. Visual impairment was moderate (13.3%), severe (73.3%), profound (6.7%) and near blindness in 6.7%. Telescopes prescribed in 33.4%, video magnifier in 46.7%. Questionnaire scores were significantly improved for distant rather than near tasks (P≤0.05) after training. LVAs rehabilitation is an effective method of improving vision in pediatric visual defects secondary to CNS tumors.

20 Scleral buckling combined with internal cyclopexy for severe traumatic cyclodialysis cleft in open globe injuries

Bo Chen , Gao-Xiang Wang , Xian Zhang , Hong Yang

2019, 12(10):1649-1653. DOI: 10.18240/ijo.2019.10.20

[Abstract](836) [HTML](252) [PDF 752.33 K](641)

Abstract:
This study aimed to evaluate the effect of scleral buckling combined with internal cyclopexy on the treatment of severe traumatic cyclodialysis cleft in open globe injuries (OGIS). This retrospective study recruited 10 patients of 10 eyes. With our surgical intervention, all the 10 eyes achieved retinal and ciliary body anatomic re-attachment. The choroidal ruptures in nine eyes were closed with complete choroidal reattachment. Postoperative best-corrected visual acuity of nine eyes had various improvements. The mean intraocular pressure was increased from 8.9±2.6 mm Hg to 13.4±4.4 mm Hg. Eventually, six eyes underwent silicone oil (SO) removal without complications, two eyes still had SO tamponade and two eyes became SO-dependent eyes. The result shows that internal direct cyclopexy combined with scleral buckling is an effective treatment for severe traumatic cyclodialysis cleft in OGIS.

21 Management of cataract in keratoconus: early visual outcomes of different treatment modalities

Nicolas Arej , Wassef Chanbour , Karen Zaarour , Mazen Amro , Hala El-Rami , Fadi Harb , Elias Jarade

2019, 12(10):1654-1658. DOI: 10.18240/ijo.2019.10.21

[Abstract](1383) [HTML](250) [PDF 360.78 K](631)

Abstract:
A review of 31 eyes with keratoconus who developed cataract and underwent phacoemulsification. Visual acuities were measured 1mo postoperatively. Six eyes with a history of good corrected distance visual acuity (CDVA) and a similar refractive and topographic astigmatic axis were implanted with toric intraocular lenses (IOLs). The mean postoperative uncorrected distance visual acuity (UDVA) was 0.2 logMAR with a spherical equivalent (SE): 0.75D. Eleven eyes with a history of good CDVA and different refractive and topographic axis were implanted with monofocal IOL+/-Toric implantable collamer lenses to treat anisometropia and ametropia; mean UDVA was 0.25 logMAR with a mean SE: -0.51 D postoperatively. Six eyes with poor CDVA were first treated with intra-corneal ring segments, followed by phacoemulsification, the mean postoperative UDVA was 0.82 logMAR with an SE: 0.22 D. Eight eyes had advanced ectesia and received combined phacoemulsification and penetrating keratoplasty. Our approach is efficient in addressing ametropia after cataract surgery in keratoconic eyes.

22 Adenovirus-mediated corneal endotheliitis: a case report

Shuang-Yong Wang , Bei Li , Dong-Hao Li , Ying Tian

2019, 12(10):1659-1661. DOI: 10.18240/ijo.2019.10.22

[Abstract](929) [HTML](254) [PDF 1.02 M](647)

Abstract:

23 Full-thickness scleral incisions technique for the treatment of a cyclodialysis cleft following ab interno trabeculotomy

Daniela Alvarez-Ascencio , Jesus Jimenez-Roman , Rafael Castañeda-Diez , Gabriel Lazcano-Gomez

2019, 12(10):1662-1665. DOI: 10.18240/ijo.2019.10.23

[Abstract](802) [HTML](253) [PDF 1.18 M](1293)

Abstract:

24 Retinal nerve fiber and ganglion cell layer thinning in hereditary and acquired mitochondrial optic neuropathies

Josef Finsterer

2019, 12(10):1666-1666. DOI: 10.18240/ijo.2019.10.24

[Abstract](730) [HTML](246) [PDF 230.01 K](527)

Abstract:
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Volume 12,Issue 10,2019 Table of Contents