Abstract:AIM: To construct functional human full-thickness corneal replacements. METHODS: Acellular porcine corneal matrix (APCM) was developed from porcine cornea by decellulariztion. The biomechanical properties of anterior-APCM (AAPCM) and posterior-APCM (PAPCM) were checked using uniaxial tensile testing. Human corneal cells were obtained by cell culture. Suspending ring was designed by deformation of an acupuncture needle. MTT cytotoxicity assay was used to check the cytotoxicity of suspending ring soaking solutions. A new three-dimensional organ culture system was established by combination of suspending ring, 48-well plate and medium together. A human full-thickness corneal substitute was constructed from human corneal cells with AAPCM in an organ coculture system. Biochemical marker expression of the construct was measured by immunofluorescent staining and morphological structures were observed using scanning electron microscopy. Pump function and biophysical properties were examined by penetrating keratoplasty and follow-up clinical observations. RESULTS: There were no cells in the AAPCM or PAPCM, whereas collagen fibers, Bowman’s membrane, and Descemet’s membrane were retained. The biomechanical property of AAPCM was better than PAPCM. Human corneal cells grew better on the AAPCM than on the PAPCM. There was no cytotoxicity for the suspending ring soaking solutions. For the constructed full-depth human corneal replacements keratocytes scattered uniformly throughout the AAPCM and expressed vimentin. The epithelial layer was located on the surface of Bowman’s membrane and composed of three or four layers of epithelial cells expressing cytokeratin 3. One layer of endothelial cells covered the stromal surface of AAPCM, expressed Na+/K+ATPase and formed the endothelial layer. The construct was similar to normal human corneas, with many microvilli on the epithelial cell surface, stromal cells with a long shuttle shape, and zonula occludens on the interface of endothelial cells. The construct withstood surgical procedures during penetrating keratoplasty. The corneal transparency increased gradually and was almost completely restored 7d after surgery. CONCLUSION: AAPCM is an ideal scaffold for constructing full-thickness corneal replacement, and functional human full-thickness corneal replacements are successfully constructed using AAPCM and human corneal cells.

Abstract:AIM: To investigate the alterations in both structure and contractile responsiveness of ocular ciliary artery (OCA) in spontaneously hypertensive rat (SHR). METHODS: In this experiment, 20-week-old male SHR and Wistar Kyoto rat (WKY) were studied. The heart rate (HR), the blood pressure (BP; the systolic BP and the diastolic BP) of rats with an electronic sphygmomanometer were measured. Vascular morphometry and isometric tension measurement were used to investigate the alterations in structure and contractility of OCA. RESULTS: A general narrowing of OCAs was observed in SHR compared to the control WYK. In SHR, the media of OCAs were thicker, the luminal diameters were smaller, and the media-to-lumen ratios were higher when compared with WKY (P<0.05). The contractions of OCAs evoked by norepinephrine were smaller in SHR compared to control (P<0.05). Then, OCAs were pretreated with iberiotoxin, L-NAME, or indomethacin 30min before norepinephrine-induced contraction. Iberiotoxin (0.1 μmol/L) has not changed the norepinephrine-induced contractions in OCAs from both groups. However, L-NAME (100 μmol/L) increased the vasoconstrictions, the increased extents were similar in SHR and WKY (P>0.05). Indomethacin (10 μmol/L) decreased the contractions induced by norepinephrine in OCAs from WKY (P<0.05), but did not change those contractions in vessels from SHR (P>0.05). CONCLUSION: Our results demonstrate that the structure and function of OCAs are altered in hypertension. OCAs from SHR are remodeled with decreased lumen diameter and increased media-to-lumen ratio. Moreover, the contractile responsiveness of OCAs from SHR is diminished due to the disruption of vasoconstrictive effect of prostaglandins.

Abstract:AIM: To explore the protective effect of zeaxanthin on human limbal and conjunctival epithelial cells against UV-radiation and excessive oxidative stress. METHODS: Human limbal and conjunctival epithelial cells were isolated from cadaver and cultured in vitro. They were challenged with UVB radiation and H2O2 with and without zeaxanthin pretreatment. Cell viability, p38 and c-JUN NH(2)-terminal kinase (JNK) phosphorylation, IL-6, IL-8 and MCP-1 secretion and malondialdehyde (MDA) content were measured. RESULTS: Zeaxanthin had no measurable cytotoxicity on limbal or conjunctival epithelial cells when used at concentrations of 5 μg/mL and below. At 30 mJ/cm2 UVB, the pretreatment of zeaxanthin increased the percentage of live cells from 50% to 69% (P=0.01) and from 66% to 75% (P=0.05) for limbal and conjunctival epithelial cells, respectively. The concentrations of IL-6, IL-8 and MCP-1 in the culture medium reduced to 66% (for IL-6 and MCP-1) and 56% (for IL-8) of the levels without zeaxanthin. This was accompanied by reduced p38 and JNK protein phosphorylation. Pretreatment of zeaxanthin also reduced intracellular MDA content caused by H2O2 stimulation from 0.86 μmol/L to 0.52 μmol/L (P=0.02) in limbal epithelial cells and from 0.96 μmol/L to 0.56 μmol/L in conjunctival epithelial cells (P=0.03). However, zeaxanthin did not have significant effect on H2O2-induced cell death in limbal or conjunctival epithelial cells. CONCLUSION: Zeaxanthin is an effective reagent in reducing the detrimental effect of UV-radiation and oxidative stress on ocular surface epithelial cells.

Abstract:AIM: To analyze the expression of uncoupling protein 2 (UCP2) in retinal pigment epithelium (RPE) cells at the different human age, further explore the possible new target of RPE cells protection. METHODS: Adult retinal pigment epithelial-19 (ARPE-19) cells and the primary RPE cells at the different age (9-20y, RESULTS: Cells from the donors more than 60y are larger and more fibroblastic in appearance compared to ARPE-19 cells and those primary cultures obtained from the younger individuals by using phase-contrast micrographs. Results of RT-PCR, Western blot and confocal microscopy all showed that UCP2 was highly expressed in ARPE-19 cells and in the younger primary cultured human RPE cells at the age of 9-20y and 50-55y, whereas lower expression of UCP2 was measured in the older primary cultured human RPE cells at the age more than 60y. CONCLUSION: Expression of UCP2 gene is decreased in aged RPE cells, promoting the lower ability of anti-oxidation in these cells. It is indicated that UCP2 gene might be a new target for protecting the cells from oxidative stress damage.

Abstract:AIM: To investigate changes in the rabbit retina after short-term and small amounts tamponade of perfluorooctane (PFO). METHODS: New Zealand rabbits were used, and 48 eyes were randomly and evenly assigned into four different groups. The PFO groups received a residue of 0.1 mL of PFO for ophthalmic surgery or 0.1 mL of F-Octane at the end of surgery; eyes from the pars plana vitrectomy (PPV) group were filled with balanced salt solution and those having not received surgical intervention served as controls. Eyes were collected at 1, 4 and 12wk and studied. RESULTS: Under a microscope, nuclear counts of the inner nuclear layer (INL) and outer nuclear layer (ONL) did not differ among the four groups at all time points; however, slight disarrangement of the ONL and occasional vacuolization of the INL were found in the inferior retina only at 12wk in two PFO groups. Four of the groups had similar results of Caspase-3 and TNF-α staining at all time points. Alternatively, IL-8 was increased in PFOa and PPV control groups at 4wk and in all three PPV groups at 12wk; also, the apoptotic index (%) was similarly increased in all three PPV groups at 4 and 12wk. CONCLUSION: Both PFOs are well tolerated in rabbit eyes for up to 12wk, which suggests that they can be used safely as intraoperative tools or for short-term and small amounts tamponade after surgery.

Abstract:AIM: To evaluate the effect of prophylactic administration of nepafenac in prevention of macular edema occurring in diabetic patients after phacoemulsification and to investigate the correlation between optical coherence tomography (OCT) foveal thickness and multifocal electroretinogram (MF-ERG) parameters. METHODS: The study included two groups. Group 1 included 50 diabetic patients with senile cataract (50 eyes, 30 females, 20 males, aged 55±7y) received nepafenac 0.1% eye drop. Group 2 included another 50 diabetic patients with senile cataract (50 eyes, 22 female, 28 males, aged 53.8±8y) did not receive nepafenac. All patients were followed up for 3mo postoperatively. OCT and MF-ERG were done preoperative and at 1wk, 1, 2 and 3mo. RESULTS: The mean foveal thickness was statistically significantly lower in Group 1. Five eyes in Group 2 developed clinical cystoid macular oedema (CMO) (10%), and no patients in Group 1 developed central macular thickening more than 50 μm. There were insignificant differences in MF-ERG amplitudes and latencies between the two groups except in the five eyes that developed CMO, there statistically significant reduction of MF-ERG amplitude with increase in foveal thickness. CONCLUSION: Perioperative nepafenac reduces the incidence of CMO following uncomplicated phacoemulsification significantly. Nepafenac has no side effects.

Abstract:AIM: To investigate the abnormalities in the meibomian gland in patients with dry eye disease (DED) associated with chronic ocular graft-versus-host disease (coGVHD) in comparison with Sjögren’s syndrome (SS), a major form of aqueous deficient DED and meibomian gland dysfunction (MGD), a common cause of evaporative DED. METHODS: A total 135 eyes of 135 subjects included in this study: patients with DED associated with coGVHD (n=30), patients with SS (n=35), patients with MGD (n=35), and normal controls (n=35). All participants completed the Ocular Surface Disease Index (OSDI) questionnaire, ocular surface examination [Schirmer test, tear film breakup time (TFBUT), and ocular surface staining], and meibomian gland assessment [meiboscore (gland dropout detected on meibography using infrared camera of the Keratograph 5M), meibum expressibility score (MES), meibum quality score (MQS), lid margin abnormality]. In addition, correlations of meibomian gland characteristics with ocular surface parameters as well as disease severity score were investigated in coGVHD group. RESULTS: The coGVHD group showed significantly higher meiboscore, MES, and MQS than the other 3 groups (all P<0.05). In the coGVHD group, parameters of meibomian gland showed a significant correlation each other and those of ocular surface. The correlation between meibomian gland parameters and severity score of coGVHD was also established (meiboscore, r=0.62; MES, r=0.47; MQS, r=0.47; lid margin abnormality score, r=0.55; all P<0.05). CONCLUSION: Patients with DED associated with coGVHD show poorer gland morphology and worse gland function than other types of DED. In addition, meibomian gland damage is not only associated with ocular surface damage but also disease severity of coGVHD.

Abstract:AIM: To assess the inter-observer agreement and reliability as well as intra-observer repeatability for lacrimal scintigraphy (LS) reports with and without considering the irrigation test results. METHODS: A prospective, observational, cross sectional study. Two masked clinicians (lacrimal surgeon and nuclear medicine specialist) independently reported 100 LS images (50 patients of >6 years of age with unilateral anophthalmic socket) in a university hospital. The lacrimal surgeon performed a diagnostic irrigation test and repeated the report of the same LS images 2y after the first report (intra-observer agreement). A weighted Kappa analysis was performed to determine inter-observer agreement and reliability as well as intra-observer repeatability for the type (normal, partial and complete obstruction) and location (presac, preduct, and intraduct) of the obstruction. Subgroup analysis was also performed with consideration of irrigation test results. RESULTS: A significantly moderate agreement was found between lacrimal surgeon and nuclear medicine specialist for both the type (Kappa=0.55) and location (Kappa=0.48) of obstruction. Agreement values were higher for the type (Kappa=0.61 vs 0.41) and location (Kappa=0.56 vs 0.31) of obstruction in cases with normal than abnormal irrigation test. Strong and significant intra-observer (lacrimal surgeon) repeatability was found for both the type (Kappa=0.66) and location (Kappa=0.69) of obstruction. LS showed no to slight reliability based on irrigation test. CONCLUSION: A moderate agreement is found between lacrimal surgeon and nuclear medicine specialist regarding the interpretation of LS suggesting the importance of consensus groups among nuclear medicine specialists and lacrimal surgeons to create a common language for interpretation of LS. Intra-observer repeatability is strong for the lacrimal surgeon.

Abstract:AIM: To describe and compare corneal sensation and morphological changes of sub-basal corneal nerves by in vivo laser scanning confocal microscopy (LSCM) in herpes simplex virus (HSV) keratitis/uveitis and contralateral, clinically unaffected eyes. METHODS: A prospective clinical study included 30 HSV eyes and 30 contralateral eyes of 30 patients, diagnosed with unilateral HSV keratitis/uveitis. Both eyes underwent a complete ophthalmological examination, Cochet-Bonnet aesthesiometry and LSCM of the central cornea, using the Heidelberg Retina Tomograph III Rostock Cornea Module. After 6mo, the same examination of the HSV affected and contralateral, clinically unaffected eyes was performed. RESULTS: HSV eyes, as compared to contralateral eyes, demonstrated a significant decrease in mean corneal sensation (3.1±1.6 vs 5.3±0.8 cm), total nerve fibres number (5.7±4.4 vs 15.1±5.4), nerve branches (3.4±3.0 vs 8.4±4.7), main nerve trunks (2.3±1.6 vs 5.8±2.2), and nerve fibres density (7.5±5.6 vs 18.1±5.3 mm/mm2, P<0.05). There was no significant difference between keratitis and uveitis eyes in mean corneal sensation and nerve fibres parameters. After 6mo, corneal sensation and sub-basal nerve fibres parameters were increased significantly, but did not reach the parameters of contralateral, clinically unaffected eyes. CONCLUSION: Corneal aesthesiometry and LSCM in HSV affected eyes reveals a significant decrease of corneal sensation and sub-basal nerve fibres which recovers at 6mo but does not reach the normal level.

Abstract:AIM: To evaluate the interchangeability of keratometric and asphericity measurements provided by three measurement systems based on different optical principles. METHODS: A total of 40 eyes of 40 patients with a mean age of 34.1y were included. In all cases, a corneal curvature analysis was performed with IOL-Master (IOLM), iDesign 2 (ID2), and Sirius systems (SIR). Differences between instruments for flattest (K1) and steepest (K2) keratometric readings, as well as for magnitude and axis of corneal astigmatism were analyzed. Likewise, differences in asphericity (Q) between SIR and ID2 were also evaluated. RESULTS: Mean differences between devices for K1 were 0.20±0.21 (P<0.001), -0.12±0.36 (P=0.046) and -0.32±0.36 D (P<0.001) for the comparisons IOLM-SIR, IOLM-ID2 and SIR-ID2, respectively. The ranges of agreement for these comparisons between instruments were 0.41, 0.70, and 0.70 D. For K2, mean differences were 0.31±0.33 (P<0.001), -0.08±0.43 (P=0.265) and -0.39±0.38 D (P<0.001), with ranges of agreement of 0.65, 0.84, and 0.74 D. Concerning magnitude of astigmatism, ranges of agreement were in the limit of clinical relevance (0.49 D, P=0.011; 0.55 D, P=0.386; 0.43 D, P=0.05). In contrast, ranges of agreement were clinically relevant for astigmatic axis (26.68o, 33.83o and 18.37o, P≥0.121) and for Q between SIR and ID2 (0.16, P<0.001). CONCLUSION: The keratometric corneal power, astigmatic axis and asphericity measurements provide by the three systems evaluated cannot be considered as interchangeable, whereas measurements of corneal astigmatism obtained with SIR and ID2 can be considered as interchangeable for clinical purposes.

Abstract:AIM: To identify risk factors associated with post-cataract surgery endophthalmitis (PCE) in type 2 diabetic patients. METHODS: A hospital-based retrospective case-control study was conducted on 194 type 2 diabetic patients undergoing cataract surgery in Rajavithi Hospital from January 2007 to December 2015. Fifteen patients with PCE were included as the case group and 179 patients without PCE were included as the control group. Potential factors associated with PCE among both groups including demographics, pre-operative characteristics, surgical settings and complications, were statistically analyzed using Chi-square testing and a logistic regression model. RESULTS: Within the case group, 53% were females and the median age was 68y. Univariate analysis of pre-operative characteristics, surgical settings and complications revealed that recent pre-operative fasting plasma glucose, insulin therapy, presence of diabetic retinopathy, and severe non-proliferative or proliferative diabetic retinopathy were significantly associated with PCE. In a multivariate analysis adjusting for blood glucose level, insulin treatment was the only significant factor associated with an increased risk of PCE (OR 3.9, 95%CI 1.0-15.0, P=0.04) compared to patients without insulin treatment. The most common causative organisms were gram-positive bacteria (89%). Staphylococcus species represented the most common group (67%). Median best corrected visual acuity at 1-month and 3-month follow-up was equal at 0.7 logMAR (20/100). CONCLUSION: The authors identify insulin treatment as the only risk factor associated with endophthalmitis after cataract surgery in type 2 diabetic patients. Further studies with serum levels of pre-operative glycated hemoglobin (HbA1c) and post-operative fasting plasma glucose level are essential to truly demonstrate the role of peri-operative glycemic markers as a risk factor for PCE.

Abstract:AIM: To compare visual quality in cataract patients with low corneal astigmatism who underwent intraocular lens (IOL) implantation, and evaluate effects of low levels of astigmatism on visual outcomes in multifocal pseudophakic eyes. METHODS: This retrospective review of clinical records comprised patients with preoperative regular corneal astigmatism of 0.75-1.0 diopters (D) with-the-rule or 0.5-0.75 D against-the-rule who had uneventful cataract surgery and AcrySof IQ ReSTOR Toric-2 IOL (ART2) or AcrySof IQ ReSTOR IOL (ReSTOR) implantation. Retrospective data collection included postoperative ART2 axis rotation, uncorrected astigmatism, uncorrected entire visual acuities, distance corrected entire visual acuities, average modulation transfer function (aMTF), Strehl ratio (SR), spectacle independence, and patient satisfaction between groups. RESULTS: Mean ART2 axis rotation was 3.12°±0.70°. No secondary surgery was required to realign IOL axis. Residual astigmatism values were -0.18±0.07 D and -0.91±0.25 D in groups ART2 and ReSTOR (P<0.05). Three months postoperatively, the mean uncorrected distant, intermediate, and near visual acuities of group A were 0.01±0.05, 0.05±0.07, 0.02±0.07 logMAR, respectively; these were better than those of group R, which were 0.08±0.06, 0.15±0.12, and 0.09±0.08 logMAR, respectively (P<0.05). aMTF, SR, and spectacle independence rates were not significantly different. All patients were satisfied with postoperative results. CONCLUSION: ART2 is more suitable than ReSTOR for cataract patients with regular corneal astigmatism 0.75-1.0 D with-the-rule or 0.5-0.75 D against-the-rule.

Abstract:AIM: To study the long-term efficacy and safety of modified viscocanalostomy in Chinese people with open angle glaucoma (OAG). METHODS: This retrospective study included a total of 100 eyes from 100 Chinese patients with medically uncontrolled OAG. All the patients underwent modified viscocanalostomy with injection of viscoelastic material in the surgically created ostia of Schlemm’s canal (SC). The modifications included peeling of the inner wall of SC and the juxtacanalicular meshwork, use of mitomycin C, and loosely suturing the superficial scleral flap. Intraocular pressure (IOP), visual acuity, number of medications, laser goniopuncture data and complications were recorded. The definition of complete (qualified) success was an IOP equal to or lower than 21, 18, 16 mm Hg without (with or without) anti-glaucoma medications. RESULTS: The mean IOP was 33.5±9.9 mm Hg before surgery, 15.2±3.6 mm Hg (mean IOP reduction of 51%) at 5y after surgery, and 15.6±2.8 mm Hg (mean IOP reduction of 49.9%) at 10y after surgery (P<0.001). The number of anti-glaucoma medications dropped from 2.39±0.5 preoperatively to 0.47±0.8 at 5y and 0.67±0.8 at 10y postoperatively (P<0.001). The follow-up period was 104.5±37.0mo. The qualified success rate for an IOP of 21, 18 or 16 mm Hg or less was 84% [95% confidence interval (CI): 0.80-0.88], 73% (95%CI: 0.68-0.78), and 59% (95%CI: 0.52-0.66) after 5y, and 80% (95%CI: 0.76-0.84), 69% (95%CI: 0.64-0.74), 51% (95%CI: 0.44-0.58) after 10y, respectively. There was a relationship between age, preoperative IOP and success rate (P<0.01, P<0.05). A total of 31 eyes (31.3%) in 31 patients underwent laser goniopuncture, decreasing the IOP from 22.9±4.3 mm Hg to 16.3±2.5 mm Hg (P<0.01). Neither blebitis nor endophthalmitis occurred. CONCLUSION: Modified viscocanalostomy could be performed to lower IOP, decrease multiple anti-glaucoma drops use as well. It’s a safe procedure with less complications over 10y in Chinese individuals with OAG.

Abstract:AIM: To prospectively assess the cumulative prevalence and management of open angle glaucoma (OAG), including primary open angle glaucoma (POAG) with high and normal-pressure, as well as pseudoexfoliative glaucoma (PEXG), in patients with central/hemicentral retinal vein occlusions (RVOs) over a 3-year follow-up period. METHODS: The study encompassed 57 patients with unilateral acute central/hemicentral RVOs. A complete ophthalmic examination of both eyes was undertaken for all patients. Patients with OAGs associated with central/hemicentral RVOs were treated with the current ocular hypotensive medications used worldwide and/or surgery and aimed to reduce the intraocular pressure (IOP) by 30% from baseline values for the 3 OAG forms existing in our series. The cumulative prevalence of OAG and the efficacy of treatment were evaluated. RESULTS: OAG was observed in 3 clinical forms, namely, POAG with increased IOP in 4 patients, POAG with normal IOP in 3 patients, and PEXG in 3 patients. The cumulative prevalence of OAG was 19.6% (95%CI: 8.7-30.5). Using available ocular hypotensive medications (8 patients) and trabeculectomy (2 patients), the IOP decreased significantly from 24.3±4.36 mm Hg to 16.55±2.85 mm Hg, a reduction of 31.89% compared with baseline values. Glaucoma progression was not detected in any of the cases. CONCLUSION: The high value of the cumulative prevalence of OAG is a risk factor for the development of venous occlusion. The treatment of glaucoma prevented its progression over a follow-up period of 3y.

Abstract:AIM: To investigate the incidence and subsequent changes of outer retinal tubulations (ORTs) in diabetic macular edema (DME) underwent anti-vascular endothelial growth factor (VEGF) therapy, and to assess the possibility of ORT as a biomarker of DME severity or response to anti-VEGF therapy. METHODS: This retrospective and descriptive study included a total of 228 patients (435 eyes) with DME and treated with intravitreal anti-VEGF agents between March 2016 and January 2018. Patients were divided into 2 groups according to the presence of ORTs. High-resolution spectral-domain optical coherence tomography (SD-OCT) images acquired by vertical and horizontal scans and over consecutive visits were analyzed. The evolution of ORT over time, type of fluid and subfoveal photoreceptor integrity on OCT imaging was also assessed. RESULTS: ORTs were identified in 108 eyes of 435 eyes with an overall incidence rate of 24.83% at baseline. ORTs were prone to locate adjacent to the lesions of exudation and/or cystoid edema and possibly situated in outer nuclear layer (ONL), outer plexiform layer (OPL) and/or inner nuclear layer (INL) in eyes with DME. The formation process of ORT led to focal downward displacement of OPL and INL toward RPE near the lesion. During the follow up, 45 eyes had steady ORTs and 63 eyes had dynamic variants in ORTs, including disappearance, reappearance, collapse, diminution, and enlargement. There were higher proportion of closed ORTs and fewer proportion of forming ORTs in eyes with steady ORTs, which showed a statistically significance when compared with eyes with variant ORTs (P=0.006, P=0.017, respectively). The eyes without ORTs had significantly better final best corrected visual acuity (BCVA) and more BCVA change than those eyes with ORTs in DME patients after anti-VEGF therapy (P=0.023, P=0.009, respectively). The disruption of subfoveal photoreceptor integrity in eyes with ORTs was more serious than that in eyes without ORTs (P=0.013). The proportion of stable vision in eyes with ORTs was significantly higher than that in eyes without ORTs, showing statistical significance (P=0.016). ORTs were associated with worse visual prognosis due to damage of the subfoveal photoreceptor integrity. CONCLUSION: ORTs have a high incidence and changes over time in DME with anti-VEGF treatment and may be located at various retinal layers. Persistent ORT can be as a negative biomarker of outcome of DME.

Abstract:AIM: To investigate the characteristics of postoperative central visual field defect (cVFD) in patients with macular hole (MH). METHODS: Eighteen eyes from 18 MH patients were involved in this retrospective study which reviewed square root of loss variance (sLV) and mean defect (MD) of the visual field test in all subjects. The relationship between cVFD and MH stage, as well as the postoperative ellipsoid zone disruption were evaluated using Spearman’s correlation test. RESULTS: Our analysis determined Spearman coefficient is 0.705 for the correlation between sLV and MH stage (P<0.01), 0.877 for the correlation between sLV and postoperative ellipsoid zone disruption (P<0.01) and 0.721 for the correlation between MD and postoperative ellipsoid zone disruption (P<0.01). A significant relationship was also detected between postoperative ellipsoid zone disruption and MH stage (r=0.470, P<0.05). Univariate regression analysis indicated that sLV and MD were associated with postoperative ellipsoid zone disruption (P<0.01, P<0.01, respectively). CONCLUSION: Postoperative cVFD is highly correlated with MH stage and postoperative ellipsoid zone disruption in patients with MH.

Abstract:AIM: To investigate serum levels of soluble CD146 (sCD146) and vascular endothelial growth factor receptor 2 (VEGFR2) in patients with age-related macular degeneration (AMD). METHODS: Eighty-eight patients with exudative AMD and 45 sex- and age-matched healthy controls were enrolled in this study conducted in China. Serum samples was obtained from the patients with exudative AMD and from the controls. Serum sCD146 and VEGFR2 protein levels were measured using an enzyme-linked immunosorbent assay. RESULTS: We found that serum sCD146 and VEGFR2 protein levels were significantly higher in the patients with exudative AMD group than in the controls (t=3.859, P<0.001 and t=3.829, P<0.001, respectively). Serum sCD146 levels were significantly higher in patients with classic choroidal neovascularization (CNV) than in those with occult CNV (t=9.899, P<0.001). There was a significant difference in the trend for exudative AMD in the highest versus lowest quartile of circulating sCD146 levels (χ2=10.29, P=0.001). The receiver operating characteristic curve analysis showed that the area under the curve was 0.696 for sCD146 (95%CI: 0.601-0.791) with an optimum diagnostic cut-off value of 157.16 ng/mL, a sensitivity of 55.7%, and a specificity of 82.2%. CONCLUSION: The serum sCD146 level increases and may be a biomarker for exudative AMD.

Abstract:AIM: To determine the discriminating performance of the macular ganglion cell-inner plexiform layer (GC-IPL) parameters between all the consecutive stages of glaucoma (from healthy to moderate-to-severe glaucoma), and to compare it with the discriminating performances of the peripapillary retinal nerve fiber layer (RNFL) parameters and optic nerve head (ONH) parameters. METHODS: Totally 147 eyes (40 healthy, 40 glaucoma suspects, 40 early glaucoma, and 27 moderate-to-severe glaucoma) of 133 subjects were included. Optical coherence tomography (OCT) was obtained using Cirrus HD-OCT 5000. The diagnostic performances of GC-IPL, RNFL, and ONH parameters were evaluated by determining the area under the curve (AUC) of the receiver operating characteristics. RESULTS: All GC-IPL parameters discriminated glaucoma suspect patients from subjects with healthy eyes and moderate-to-severe glaucoma from early glaucoma patients (P<0.017, for all). Also, minimum, inferotemporal and inferonasal GC-IPL parameters discriminated early glaucoma patients from glaucoma suspects, whereas no RNFL or ONH parameter could discriminate between the two. The best parameters to discriminate glaucoma suspects from subjects with healthy eyes were superonasal GC-IPL, superior RNFL and average c/d ratio (AUC=0.746, 0.810 and 0.746, respectively). Discriminating performances of all the parameters for early glaucoma vs glaucoma suspect comparison were lower than that of the other consecutive group comparisons, with the best GC-IPL parameters being minimum and inferotemporal (AUC=0.669 and 0.662, respectively). Moreover, minimum GC-IPL, average RNFL, and rim area (AUC=0.900, 0.858, 0.768, respectively) were the best parameters for discriminating moderate-to-severe glaucoma patients from early glaucoma patients. CONCLUSION: GC-IPL parameters can discriminate glaucoma suspect patients from subjects with healthy eyes, and also all the consecutive stages of glaucoma from each other (from glaucoma suspect to moderate-to-severe glaucoma). Further, the discriminating performance of GC-IPL thicknesses is comparable to that.

Abstract:AIM: To investigate sectoral changes in the mean peripapillary choroidal thickness (PCT) in patients with unilateral branch retinal vein occlusion (BRVO). METHODS: This retrospective, interventional study included 41 patients with acute, unilateral BRVO without macular edema. All patients completed at least a 6-month follow-up period. The PCT was measured at eight locations (temporal, superotemporal, superior, superonasal, nasal, inferonasal, inferior, and inferotemporal). In addition to calculating the average of all locations, the peripapillary choroidal area was divided into four sectors: superior (average of superotemporal PCT, superior PCT, and superonasal PCT), temporal, inferior (average of inferotemporal PCT, inferior PCT, and inferonasal PCT), and nasal. RESULTS: In the BRVO-affected eyes, the mean PCT was 177.7±69.8 μm (range, 70.1-396.0 μm) at baseline and 127.8±54.8 μm (range, 56.4-312.1 μm) at 6mo (P<0.001). In the non-affected contralateral eyes, the mean PCT was 192.5±60.6 μm (range, 61.4-365.0 μm) at baseline and 165.9±61.1 μm (range, 56.8-326.8 μm) at 6mo (P<0.001). In sectoral analysis, the mean PCT in each sector was significantly reduced in over 6mo in the BRVO-affected eyes (all P<0.001). In the non-affected contralateral eyes, the mean PCT was not significantly changed in any sector over the 6-month follow-up period (superior sector, P=0.143; temporal sector, P=0.825; inferior sector, P=0.192; and nasal sector, P=0.599). CONCLUSION: Sectoral analysis shows that the mean PCTs in all sectors are reduced significantly over 6mo in the BRVO-affected eyes, but not in the non-affected contralateral eyes.

Abstract:AIM: To investigate the incidence of abrupt visual loss and its associated factors, during anti-vascular endothelial growth factor (VEGF) treatment for type 3 neovascularization. METHODS: This retrospective study included 137 eyes that were newly diagnosed with type 3 neovascularization. All eyes were treated with anti-VEGF therapy. Abrupt visual loss was defined as loss of 5 or more lines in best-corrected visual acuity (BCVA) in comparison to the previous visit. The incidence and timing of abrupt visual loss as well as the factors associated with it, were determined. In addition, the BCVA at the final follow-up was compared between the eyes with and those without abrupt visual loss. RESULTS: The mean follow-up period was 42.4±18.9mo after diagnosis, and abrupt visual loss was noted in 22 eyes (16.1%) at a mean of 19.6±13.9mo. Abrupt visual loss was found to be associated with subretinal hemorrhage in 11 eyes (50.0%), development of or increase in the height of pigment epithelial detachment with fluid in 8 eyes (36.4%), and tears in the retinal pigment epithelium in 3 eyes (13.6%). The logarithm of minimum angle of resolution (logMAR) mean BCVA at the final follow-up was 2.07±0.67 (Snellen equivalents: 20/2349) and 1.00±0.55 (20/200) in eyes with and without abrupt visual loss, respectively. BCVA was significantly worse in the eyes with abrupt visual loss (P<0.001). CONCLUSION: Abrupt visual loss is noted in 16.1% of patients with type 3 neovascularization and is associated with poor visual outcome. Additional studies are needed to determine how abrupt visual loss can be prevented.

Abstract:AIM: To evaluate the effect of age on visual and refractive results after laser in situ keratomileusis (LASIK) obtained with a mechanical microkeratome or a femtosecond laser. METHODS: Retrospective, nonrandomized, cohort study. A total of 3826 eyes were included in the study (1725 eyes treated with mechanical LASIK and 2101 eyes treated with femtosecond LASIK). The relationship between patient age and the 3-month postoperative visual and refractive results of both procedures were analyzed by linear regression analysis. RESULTS: Three months postoperatively, we found a significant correlation between age and the postoperative spherical equivalent (SE; r2=0.004, P=0.006), efficacy (r2=0.006, P=0.001), and safety indexes (r2=0.05, P=0.0001) in the mechanical LASIK group. On the other hand, we found a significant correlation between age and the postoperative SE (r2=0.02, P=0.0001) and the efficacy index (r2=0.01, P=0.0001) but not the safety index in the femtosecond laser group. Mechanical LASIK provided slightly but significantly better efficacy and predictability in patients 18 to 40 years of age and femtosecond LASIK did so in patients older than 40 years of age. The femtosecond laser provided better safety results than the mechanical microkeratome in both age groups. CONCLUSION: A tendency toward undercorrection and less predictability is found with aging after myopic LASIK regardless of whether the flap was created with a mechanical microkeratome or a femtosecond laser. However, femtosecond laser provides significantly better outcomes in terms of efficacy, safety and predictability compared to mechanical microkeratome for the correction of myopia in patients over 40y.

Abstract:AIM: To determine the distributions of central corneal thickness (CCT) and intraocular pressure (IOP) in emmetropic eyes of healthy children of Palestine. METHODS: This representative cross sectional study included a total of 1156 eyes from 578 healthy school children aged 7-15y. Inclusion criteria included emmetropia, no previous history of ocular or systemic diseases, no previous history of contact lens use, and the availability of both eyes. CCT and IOP were measured using ultrasound pachymeter and Goldmann applanation tonometer, respectively. The relationship of the results with age and gender was investigated. RESULTS: The mean age of school children was 11.13±2.8y. Mean CCT was 542.2±37.4 and 544.3±39.2 μm for right and left eyes, respectively. Mean IOP was 12.5±2.2 and 12.3±2.2 mm Hg for right and left eyes, respectively. A positive correlation was observed between CCT and IOP of the right eye (P<0.001, R=0.358) and CCT and IOP of the left eye (P<0.001, R=0.324). No significant differences were observed in CCT and IOP due to age or gender (P>0.05). There were significant differences in mean CCT and IOP between right and left eyes (P=0.004, P=0.001, respectively). CONCLUSION: A population profile of CCT and IOP is established in Palestinian children for the first time. Mean CCT is comparable to some studies but differ from others. Mean IOP is considerably lower than that of majority children of other ethnic groups. Intereye difference of more than 36 μm in CCT, and 5 mm Hg in IOP should prompt evaluation for potential ocular disorders.

Abstract:AIM: To investigate the Chinese version of the Low Vision Quality of Life Questionnaire (CLVQOL) as an instrument for obtaining clinically important changes after cataract surgery. METHODS: Patients underwent cataract surgery in Shanghai General Hospital, Shanghai Jiao Tong University, who fit the inclusion criteria were recruited. Two CLVQOLs were administered, including a preoperative CLVQOL and a CLVQOL at the end of the 3mo follow-up period, and were completed using face-to-face interviews or phone interviews conducted by trained investigators. The minimal clinically important difference (MCID) was calculated using an anchor-based method and a distribution method. In addition, the responsiveness of the questionnaire was measured. RESULTS: A total of 155 residents were enrolled. The average visual acuity (VA) preoperatively was 0.08 (SD=0.05), and it increased to 0.47 (SD=0.28) at the end of follow-up. Statistically significant positive changes in the CLVQOL scores indicated significant improvement of vision related quality of life after cataract surgery. With the larger value between the two results as the final value, the MCID values of the CLVQOL (scores of the four scales as well as the total score) were 8.94, 2.61, 4.34, 3.10 and 17.63, respectively. The CLVQOL has both good internal and external responsiveness. CONCLUSION: CLVQOL scores are appropriate instruments for obtaining clinically important changes after cataract surgery. This study is an effective exploration for establishing cataract surgery efficacy standards, which helps clinical and scientific research workers in ophthalmology to gain a more in-depth understanding when using CLVQOL.

Abstract:AIM: To perform a Meta-analysis to explore the correlation between metabolic syndrome and intraocular pressure (IOP). METHODS: We searched PubMed and Embase in November 2017 for studies discussing the relationship between metabolic syndrome components and IOP in patients. Pearson correlation coefficients, odds ratios and standardized betas were extracted from inclusive studies. Heterogeneity and publication bias were checked. RESULTS: Of 295 articles, 10 met inclusion criteria and provided sufficient data for Meta-analysis. Results showed a significant positive relation between metabolic syndrome and IOP (Z=0.47, 95%CI: 0.15-0.79, P=0.005). The five components [waist circumference, hypertriglyceridemia, high blood pressure, high fasting glucose and low high density lipoprotein (HDL)-cholesterol] of metabolic syndrome all showed positive correlation with IOP except the low HDL-cholesterol which had no statistical significance. The pooled Z was 0.08 (95%CI: 0.04-0.12), 0.16 (95%CI: 0.11-0.21), 0.16 (95%CI: 0.10-0.22), 0.30 (95%CI: 0.20-0.40) and 0.12 (95%CI: 0.08-0.16), respectively. Begg’s test and Egger’s test showed no evidence of significant publication bias of this Meta-analysis. CONCLUSION: Our findings suggest that metabolic syndrome and its components are significantly associated with IOP, besides the HDL-cholesterol. This association may be used to control IOP by intervening the occurrence of metabolic syndrome.

Abstract:The aim of this study is to report and analyze the factors related with earlier occurrence of silicone oil (SO) emulsification in patients underwent pars plana vitrectomy and SO injection in our hospital. We retrospectively reviewed consecutive case series undergone both SO injection and removal in our hospital, and 182 ones were eligible. Possible related independent factors included: macula status (on/off), concomitant phacoemulsification with the surgery of SO tamponading, concomitant status of proliferative vitreoretinopathy, combined surgery of retinotomy, time to have emulsification (<6mo/≥6mo after primary SO injection), route of SO injection (anterior/posterior), lens status (aphakic/pseudophakic/phakic), anesthesia (local/general), brands and type of SO, with/without episcleral cryotherapy, with/without hypertension, with/without diabetes, with/without intraoperative use of triamcinolone acetonide. The study revealed that brand and type of SO was the significant factor related with earlier emulsification of SO. Further study was warranted to find out the underlying causes.

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Abstract:Letter to the Editor

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