Volume 12,Issue 7,2019 Table of Contents

1 Novel mutation in OCRL leading to a severe form of Lowe syndrome

Feng-Qi Zhou , Qi-Wei Wang , Zhen-Zhen Liu , Xu-Lin Zhang , Dong-Ni Wang , Mei-Mei Dongye , Hao-Tian Lin , Wei-Rong Chen

2019, 12(7):1057-1060. DOI: 10.18240/ijo.2019.07.01

[Abstract](1392) [HTML](246) [PDF 736.56 K](696)

Abstract:
AIM: To investigate the phenotype and genotype of a family with X-linked recessive Lowe syndrome. METHODS: All the members in the Chinese pedigree underwent comprehensive ophthalmologic and systemic examinations. Genomic DNA was isolated from peripheral blood of the pedigree members and 100 unrelated healthy Chinese subjects. Direct sequencing was performed to screen the exons and intron boundaries of OCRL. RESULTS: The ophthalmological and systemic examinations suggested that the affected individual had Lowe syndrome. The phenotype in the pedigree is severe and consistent among all the affected individuals except for an individual who additionally suffered from congenital heart disease and laryngeal cartilage dysplasia. Directional Sanger sequencing identified a complex mutation c.(2368_2368delG; c.2370A>C) in the Rho-GTPase activating protein domain. This complex mutation causes termination of protein synthesis at amino acid 824 and result in a new peptide with 823 amino acids (p.Ala790ProfsX34). This mutation was not detected in 100 unrelated healthy Chinese subjects. CONCLUSION: Our findings expand the phenotypic and genotypic spectrum of Lowe syndrome.

2 High glucose: activating autophagy and affecting the biological behavior of human lens epithelial cells

Dan Li , Gao-Qin Liu , Pei-Rong Lu

2019, 12(7):1061-1066. DOI: 10.18240/ijo.2019.07.02

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Abstract:
AIM: To clarify the effect of autophagy on human lens epithelial cells (HLECs) under high glucose conditions. METHODS: HLECs were cultured with different concentrations of glucose and 3-methyladenine (3-MA); the expression of autophagy-related protein LC3B was detected by Western blotting and immunofluorescence histochemistry. The migration of HLECs was quantified by scratch wound assay and the expression of transforming growth factor-β (TGF-β) was measured by real-time polymerase chain reaction. RESULTS: Compared with 5 mmol/L normal glucose treatment, 40 mmol/L glucose treatment can significantly increase the generation of autophagosome in HLECs, which could be inhibited by 0.375 mmol/L 3-MA treatment. The migration of HLECs and the expression of TGF-β in HLECs induced by high glucose were significantly suppressed by 0.375 mmol/L 3-MA treatment. CONCLUSION: Autophagy promotes HLECs cell migration and increases the expression of TGF-β after exposed to high glucose, which may relate to the development of diabetic cataract.

3 Reactive oxygen species mediates a metabolic memory of high glucose stress signaling in bovine retinal pericytes

Li-Wei Zhang , Han Zhao , Bai-Hua Chen

2019, 12(7):1067-1074. DOI: 10.18240/ijo.2019.07.03

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Abstract:
AIM: To investigate the role of reactive oxygen species (ROS) and antioxidant mechanism underlying the metabolic memory of bovine retinal pericytes (BRPs) induced by high glucose. METHODS: Effects of high glucose levels and culture time on BRPs viability were evaluated by CCK-8. BRPs were grown in high-glucose media (30 mmol/L) for 4d followed by culture in normal glucose condition (5.6 mmol/L) for 4d in an experimental group. In contrast, in negative and positive control groups, BRPs were grown in either normal-glucose media or high-glucose media for 8d, respectively. The ROS levels, apoptosis, the expression and activity of manganese superoxide dismutase (MnSOD) in BRPs, as well as the protective effect of adeno-associated viral (AAV)-mediated over expression of MnSOD were determined separately by DCHFA, ELISA and Western blot. RESULTS: Comparing the result of cells apoptosis, activity and protein expression of MnSOD and caspase-3, the cell culture system that exposed in sequence in 30 mmol/L and normal glucose for 4d was demonstrated as a suitable model of metabolic memory. Furthermore, delivery of antioxidant gene MnSOD can decrease BRPs apoptosis, reduce activated caspase-3, and reverse hyperglycemic memory by reducing the ROS of mitochondria. CONCLUSION: Increased ROS levels and decreased MnSOD levels may play important roles in pericyte loss of diabetic retinopathy. BRPs cultured in high glucose for 4d followed by normal glucose for 4d could be an appropriate model of metabolic memory. rAAV-MnSOD gene therapy provides a promising strategy to inhibit this blinding disease.

4 Pirfenidone suppresses the abnormal activation of human Müller cells after platelet-derived growth factor-BB stimulation

Yi-Jin Tao , Qin Chen , Li Wang , Xiao Yang , Qing Cun , Wen-Yan Yang , Hua Zhong

2019, 12(7):1075-1082. DOI: 10.18240/ijo.2019.07.04

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Abstract:
AIM: To determine the effect of pirfenidone on the activated human Müller cells by platelet-derived growth factor-BB (PDGF-BB). METHODS: The primary human Müller cells were separated from retinal tissues and established the pathogenic model by stimulated with PDGF-BB. The Müller cells behaviour of normal group and the model group was measured by MTT assay, Trypan blue assay, cell migration assay, and collagen contraction assay. The expression of transforming growth factor (TGF)-β1, -β2, and pigment epithelium-derived factor (PEDF) was estimated with real-time polymerase chain reaction (PCR), Western blot and immunofluorescence analyses. RESULTS: A pathogenic/proliferative model of Müller cells was established by stimulating normal cultured Müller cells with 10 ng/mL PDGF-BB for 48h. After treated with 0.2 and 0.3 mg/mL pirfenidone, the proliferation, migration and collagen contraction was statistically significantly depressed in the model group compared with the normal groups. The expression levels of TGF-β1 and TGF-β2 were significantly down-regulated, while the PEDF expression was significantly up-regulated after treated with 0.2 and 0.3 mg/mL pirfenidone in the model group. CONCLUSION: Pirfenidone effectively suppress the proliferation, migration and collagen contraction of the human Müller cells stimulated with PDGF-BB through down- regulation of TGF-β1/TGF-β2 and up-regulation of PEDF.

5 Effects of etanercept on the apoptosis of ganglion cells and expression of Fas, TNF-α, caspase-8 in the retina of diabetic rats

Qin Ye , Yu-Ni Lin , Mao-Song Xie , Yi-Hua Yao , Shu-Min Tang , Yan Huang , Xiao-Hui Wang , Yi-Hua Zhu

2019, 12(7):1083-1088. DOI: 10.18240/ijo.2019.07.05

[Abstract](1423) [HTML](241) [PDF 941.08 K](590)

Abstract:
AIM: To evaluate the effects of etanercept on the expression of Fas, tumor necrosis factor-alpha (TNF-α) and caspase-8 in the early stage of the apoptotic pathway in diabetic rats, and to explore the therapeutic effect of etanercept on diabetic retinopathy. METHODS: A total of 60 Sprague-Dawley (SD) rats were randomly and evenly divided into 3 groups with 20 rats each, including control group, and diabetic groups with or without treatment. Streptozotocin (STZ)-induced diabetic rats were established for diabetic groups. Blood glucose and body weight were measured weekly. All the rats were sacrificed at the 12wk after treatment. The expressions of Fas, TNF-α and caspase-8 in rat retina were quantitatively detected by PCR and Western blot. The leakage of Evan blue was adopted to measure the retinal vascular leakage quantitatively, and to compare it among different groups. TUNEL method was used to compare the amount of apoptotic bodies quantitatively in rat retina ganglion cells under electron microscope. RESULTS: The expressions of Fas, TNF-α and caspase-8 in each group were compared via PCR and Western blot, in which the diabetic group with treatment was lower than those without treatment (P<0.01), but all the diabetic groups were higher than the control group (P<0.01). Evans blue leakage in the diabetic treatment group was lower than those without treatment (P<0.01), but those in the control group was the lowest compared with the other two groups (P<0.01). TUNEL method showed that the apoptotic bodies of retina in the diabetic treatment group was lower than those without treatment (P<0.01), while those in the control group was the lowest compared with the other two groups (P<0.01). CONCLUSION: Etanercept can effectively reduce the expression of Fas, TNF-α and caspase-8, as well as the retinal leakage and retinal cell apoptosis in diabetic rats.

6 Down regulation of UCP2 expression in retinal pigment epithelium cells under oxidative stress: an in vitro study

Ying Liu , Yuan Ren , Xia Wang , Xu Liu , Yun Xu , Yuan He

2019, 12(7):1089-1094. DOI: 10.18240/ijo.2019.07.06

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Abstract:
AIM: To evaluate the expression of uncoupling protein 2 (UCP2) in a retinal pigment epithelium cell line (ARPE-19), under oxidative stress (OS). METHODS: ARPE-19 cells were divided into groups treated with various concentrations of hydrogen peroxide (H2O2; 0, 150, 300, 500, 700, and 900 μmol/L) for 24h, to induce oxidative damage and cell viability was assessed by MTT assay. UCP2 mRNA expression in cells treated with H2O2 was investigated by reverse transcription-polymerase chain reaction (RT-PCR). UCP2 protein expression was assessed by Western blotting and ROS levels analyzed by flow cytometry (FCM). Further, UCP2-siRNA treated cultures were exposed to H2O2 (0, 75, 150, and 300 μmol/L) for 2h and cell viability determined by MTT assay. RESULTS: Cells treated with higher concentrations of H2O2 appeared shrunken; their adhesion to adjacent cells was disrupted, and the number of dead cells increased. The results of cell viability assays demonstrated that the numbers of cells were decreased in a dose-dependent manner following treatment with H2O2. Compared with untreated controls, cell viability was significantly reduced after treatment with >300 μmol/L H2O2 (P<0.05). Cell metabolic activity was decreased with increased concentrations of H2O2 as detected by MTT assay. Levels of OS were further decreased in cells treated with UCP2-siRNA compared with those treated with H2O2 alone (P<0.05). The results of RT-PCR and Western blotting demonstrated that UCP2 expression was reduced in H2O2-treated groups compared with controls (P<0.05). FCM analysis showed that cell reactive oxygen species (ROS) levels were increased in H2O2-treated groups and further upregulated by UCP2-siRNA treatment (P<0.05). CONCLUSION: Expression levels of UCP2 are decreased in ARPE-19 cells treated with H2O2. ROS levels are further increased in cells treated with UCP2-siRNA relative to those treated with H2O2 alone. UCP2 may have a protective role in ARPE-19 cells during oxidative injury.

7 Inhibitory effect of Houttuynia cordata Thunb on LPS-induced retinal microglial activation

Ying-Hui Zhang , Le-Meng Ren , Xiao-Yun Wang

2019, 12(7):1095-1100. DOI: 10.18240/ijo.2019.07.07

[Abstract](1318) [HTML](231) [PDF 998.02 K](648)

Abstract:
AIM: To identify the effect of Houttuynia cordata Thunb (HCT) on lipopolysaccharide (LPS)-induced microglial activation and investigate its possible molecular mechanisms. METHODS: The primary retinal microglial cells were cultured from the retinas of newborn Sprague-Dawley rats and exposed to LPS, and/or HCT with different concentrations. The survival ability of retinal microglia cells was tested by standard MTT method. BrdU cell proliferation assay was used to evaluate the proliferation of retinal microglia. Inflammatory factors in the culture supernatants, including TNF-α, iNOS and IL-1β, were measured using ELISA. Microglia cells’ migration was determined with Transwell migration assay. The total p38-MAPK and phosphorylation of p38-MAPK (p-p38-MAPK) were detected with Western blot. RESULTS: Primary retinal microglia in culture exposed to LPS to induce microglia activation. Pretreatment with HCT significantly inhibited the LPS-induced cell proliferation, but not the cell viability. LPS induced inflammatory reaction in microglia and cell migration. HCT significantly reduced LPS-stimulated release of pro-inflammatory factors and decreased the number of migrating cells substantially in a concentration-dependent manner. Moreover, the protein levels of p-p38 MAPK were identified as the up regulation and co-treatment with HCT obviously inhibited the upregulation of p-p38 MAPK, but had no effect on the levels of total p38-MAPK. CONCLUSION: The data suggest that HCT inhibits LPS-induced retinal microglial activation via suppression of the p-p38-MAPK. HCT may be used for the treatment of ocular diseases characterized by over-activated microglia.

8 Astigmatic correction with implantation of a light adjustable vs monofocal lens: a single site analysis of a randomized controlled trial

Majid Moshirfar , William D. Wagner , Steven H. Linn , David F. Skanchy , Tanner W. Brown , Aaron T. Gomez , Jackson L. Goldberg , Yasmyne C. Ronquillo , Phillip C. Hoopes Jr.

2019, 12(7):1101-1107. DOI: 10.18240/ijo.2019.07.08

[Abstract](1242) [HTML](253) [PDF 2.54 M](599)

Abstract:
AIM: To evaluate the light adjustable lens (LAL) vs a standard monofocal lens in achieving target astigmatic refraction and improving postoperative uncorrected distance visual acuity (UDVA). METHODS: This randomized controlled clinical trial included 40 patients with pre-existing astigmatism and visually significant cataract. Twenty-eight patients received the LAL and 12 control patients received a monofocal intraocular lens (IOL) after cataract extraction at a single institution. The patients with the LAL underwent adjustment by ultraviolet (UV) light postoperatively plus subsequent lock-in procedures and all patients returned to clinic for follow up of study parameters at 6, 9, and 12mo. Manifest refraction, distance visual acuity, and adverse events were recorded at each visit. RESULTS: The mean cylinder before adjustment in eyes with the LAL was -0.89±0.58 D (-2.00 to 0.00 D) and -0.34±0.34 D (-1.25 to 0.00 D) after lock-in (P=1.68x10-8). The mean cylinder in patients with the monofocal lens was -1.00±0.32 D (-1.50 to -0.50 D) at 17-21d postoperatively, which was statistically different from the LAL cylinder post lock-in (P=1.43x10-6). UDVA in the LAL group was 20/20 or better in 79% of patients post lock-in with good stability over 12mo compared with 33% of the control patients with UDVA of 20/20 or better. CONCLUSION: These results demonstrate that the LAL is more effective in achieving target refractions and improving postoperative UDVA in patients with pre-existing corneal astigmatism than a standard monofocal lens.

9 Imaging characteristics and surgical management of orbital neurilemmomas

Ming-Hao Chen , Jian-Hua Yan

2019, 12(7):1108-1115. DOI: 10.18240/ijo.2019.07.09

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Abstract:
AIM: To review imaging characteristics and surgical outcomes of orbital neurilemmoma. METHODS: Retrospective review of 21 patients with orbital neurilemmoma managed at the Zhongshan Ophthalmic Center of Sun Yat-sen University from June 2005 to December 2016. All patients underwent surgical excision following preoperative imaging including ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI). RESULTS: Among these patients, 11 were male and 10 were female, with age ranging from 12 to 75y (average, 40.3y). Ultrasound of the orbit showed a roundish well-demarcated orbital mass with low or middle internal reflectivity in each case. Dark inner liquid fields were detected in 28.6% of these cases. Doppler ultrasound demonstrated blood flow signals in these masses. CT showed that the tumors were either homogeneous or heterogeneous. MRI of T1WI revealed isointense or hypointense tumors, while the T2WI indicated heterogeneous hyperintense lesions. Gd contrast MRI demonstrated heterogenous or homogeneous enhancement initiating from the wide area of the lesion. Six patients underwent lateral orbitotomy and 15 anterior orbitotomy. All tumors were completely removed. After a mean follow-up of 1.8y, 3 patients experienced reduced vision while the remaining 10 patients showed improved vision after surgery. One patient experienced a mild limitation of upward motility. No recurrence occurred. CONCLUSION: Orbital neurilemmoma is a relatively rare, benign orbital tumor. Effective diagnosis requires a combination of ultrasonography, CT and/or MRI. These imaging techniques are also vital to differentiate neurilemmomas from other orbital masses like that of cavernous hemangiomas and meningiomas. Successful treatment requires complete resection of the neurilemmomas as performed either by lateral or anterior orbitotomy. Recurrence is rare after complete removal.

10 Radiofrequency ablation micro-dissecting of eyelid nevus with XL-RFA device under operating microscope

Jing-Xin Wang , Yi-Lan Li , Yue-Ming Gao , Li-Ning Zhang , Li-Ping Huang , Qing-Hua He , Hui-Min Xie , Tian-Yu Jiang , Zi-Shan Jia , Xing-Lin Wang

2019, 12(7):1116-1121. DOI: 10.18240/ijo.2019.07.10

[Abstract](1140) [HTML](234) [PDF 817.00 K](568)

Abstract:
AIM: To study the effect of an innovative micro-dissection procedure by radiofrequency ablation (MRA) in removing eyelid nevus. METHODS: Fifty-six consecutive outpatients with eyelid nevus were treated with MRA using a monopolar device. The effect of MRA was determined after following-up for 6mo to 5y. RESULTS: Fifty-two cases (52 eyes, 92.9%) were cured once, and 4 cases (4 eyes, 7.1%) received second treatment for small residual. All cases healed well after surgery, with no pigmentation, no scars, no loss of eyelashes, no deformation of eyelid margin. There was no visual impairment after healing. CONCLUSION: MRA of eyelid nevus using the XL-RFA device is highly efficient without significant complications.

11 Changes in ocular surface status and dry eye symptoms following femtosecond laser-assisted cataract surgery

Rui-Hong Ju , Yun Chen , Hai-Song Chen , Wei-Jian Zhou , Wei Yang , Zhen-De Lin , Zhe-Ming Wu

2019, 12(7):1122-1126. DOI: 10.18240/ijo.2019.07.11

[Abstract](1826) [HTML](239) [PDF 319.97 K](632)

Abstract:
AIM: To observe the changes in ocular surface and the dry eye symptoms following femtosecond laser-assisted cataract surgery (FLACS). METHODS: Patients with no eye signs or symptoms in Guangzhou Aier Eye Hospital between October 2017 and September 2018, who underwent FLACS and intraocular lens (IOL) implantation for age-related cataract were enrolled. Tear film stability assessed with OCULUS Keratograph 5M, Schirmer’s I test (SIT), and corneal fluorescein staining (CFS) were evaluated before and after surgery at 1d, 1wk, 1, and 3mo in order. Ocular Surface Disease Index scores (OSDI) and Subjective Symptom Questionnaires (SSQs) were recorded at the same time point. RESULTS: Thirty-eight eyes of 38 patients were enrolled. The noninvasive tear film break-up time (first break-up time and average break-up time) decreased in a peak at the 1wk visit, and then increased to basic levels at 1mo. The tear meniscus height (TMH) increased transiently at 1d, and declined in the following 3mo visits. The SIT had a transient increase at 1d (P=0.357) and a decrease at 1wk and 1mo (both P<0.05) but returned to the preoperative levels at 3mo after surgery (P=0.062). CFS scores were significantly improved compared with those before surgery, and had a statistical difference (P<0.05). OSDI scores and SSQs after surgery were obviously higher, and had a statistical difference (P<0.001) but didn’t return to the basic level by 3mo. CONCLUSION: Dry eye signs and symptoms can occur immediately following FLACS and have a peak severity on day 7 postoperatively. Most signs of dry eye can return to preoperative basic levels within 3mo postoperatively. However, all cases can not recover from CFS and dry eye symptoms at 3mo postoperatively.

12 Association between the levels of prostaglandin E2 in tears and severity of dry eye

Kaevalin Lekhanont , Kanchalika Sathianvichitr , Punyanuch Pisitpayat , Thunyarat Anothaisintawee , Kitipong Soontrapa , Umaporn Udomsubpayakul

2019, 12(7):1127-1133. DOI: 10.18240/ijo.2019.07.12

[Abstract](1193) [HTML](239) [PDF 450.12 K](583)

Abstract:
AIM: To investigate the relationship between the levels of prostaglandin E2 (PGE2) in tears and dry eye disease severity based on both clinical symptoms and signs. METHODS: Tear samples were collected from 36 non-Sjögren syndrome dry eye patients (10 males and 26 females, mean age 50.11±11.17y). All participants completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent a detailed ophthalmic examination including, tear film breakup time (TBUT), ocular surface fluorescein staining, Schirmer I test, and meibomian gland assessment. The level of PGE2 in tears was measured using enzyme-linked immunosorbent assay (ELISA). The independent associations between tear PGE2 levels and other variables including demographics, OSDI scores, TBUT, Schirmer scores, ocular surface staining scores, and stage of meibomian gland dysfunction (MGD) were evaluated using linear regression analysis. RESULTS: The mean PGE2 level in tears of dry eye patients was 537.85±234.02 pg/mL. The tear PGE2 levels significantly positively correlated with OSDI scores (R=0.608, P<0.001), however, they did not significantly associate with TBUT (R=0.153, P=0.373), Schirmer scores (R=-0.098, P=0.570), ocular surface staining scores (R=0.282, P=0.095), and stage of MGD (R=-0.107, P=0.535). Male sex was significantly negatively correlated with tear PGE2 levels. CONCLUSION: The levels of PGE2 in tears are positively correlated with dry eye symptoms. However, no significant association was found between tear PGE2 levels and the results of other common dry eye diagnostic tests.

13 Mode of delivery, birth weight and the incidence of congenital nasolacrimal duct obstruction

Ayse Dolar Bilge

2019, 12(7):1134-1138. DOI: 10.18240/ijo.2019.07.13

[Abstract](1050) [HTML](241) [PDF 310.91 K](555)

Abstract:
AIM: To study any possible association of congenital nasolacrimal duct obstruction (CNLDO) with mode of delivery, birth weight and gestational age. METHODS: We retrospectively reviewed charts of all patients (n=2591) under the age of 3y who were born between April 2015 and May 2017 and were examined at the Ophthalmology Clinic of Emsey Hospital Istanbul, Turkey. We identified patients (n=105) who were diagnosed as CNLDO. The mode of delivery, birth weight and gestational age along with any adverse event during or after delivery or any other health history were determined. Birth statistical data were obtained from the hospital’s medical records database. RESULTS: Gestational age of babies who were born via cesarean section (CS) was lower than gestational age of babies who were born via normal spontaneous vaginal delivery (NSVD; P=0.002). Babies who were born via CS were found to have 3.75 times higher risk of developing NLDO when compared to babies who were born via NSVD (OR=3.754). CONCLUSION: There is a possible association between CS and CNLDO.

14 Relationship between early structural changes at cornea incision sites and surgical outcomes after phacoemulsification

Kyung Hyun Jin , Tae Gi Kim

2019, 12(7):1139-1145. DOI: 10.18240/ijo.2019.07.14

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Abstract:
AIM: To assess the early structural changes at clear corneal cataract incision sites and surgical outcomes using anterior segment optical coherence tomography (AS-OCT). METHODS: We evaluated 80 eyes of 59 patients who underwent phacoemulsification with a clear corneal incision. All incisions were evaluated 1wk, 1, and 3mo postoperatively using AS-OCT and analyzed regarding angle, length of the incision, maximal corneal thickness at the incision, and if present, corneal endothelial gap length and incision gap area. The patients were divided into two groups according to whether or not an endothelial gap was present at 1wk postoperatively (endothelial gap, group 1; no endothelial gap, group 2). We analyzed the difference in patient and surgical factors between the two groups, and compared the surgical outcome and the refractive outcome. RESULTS: An endothelial gap was observed in 56 (70.0%) of 80 eyes at 1wk postoperatively but not at 3mo postoperatively. The mean patient age was significantly higher in group 1 than in group 2. The longer the length of the corneal incision and the steeper the incision angle, the greater the length and area of the endothelial gap. In group 1, the mean change in mean keratometry of the anterior cornea was significantly greater than in group 2, and the spherical equivalent (SE) and mean numerical error indicated significant myopic changes at 1wk postoperatively. CONCLUSION: The risk of an endothelial gap increases with patient age and a long corneal incision and steep incision angle. The presence of an endothelial gap after surgery may affect the early postoperative corneal curvature and SE.

15 The process of retinal vascularization in retinopathy of prematurity after ranibizumab treatment in China

Qing-Yu Meng , Yong Cheng , Ming-Wei Zhao , Jian-Hong Liang

2019, 12(7):1146-1150. DOI: 10.18240/ijo.2019.07.15

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Abstract:
AIM: To explore the process of retinal vascularization and risk factors for retinopathy of prematurity (ROP) treated with intravitreal ranibizumab (IVR) as monotherapy. METHODS: Infants with type 1 ROP who received IVR as primary treatment from August 2014 to October 2016 at Peking University People’s Hospital’s Ophthalmology Department were included in the study. All eyes received 0.25 mg ranibizumab at initial treatment. Retinal vascularization was evaluated clinically. Potential risk factors were also recorded and examined. RESULTS: Retinal vascularization was completed in 126 eyes (62.7%), and retinal vascularization terminated in zone II and zone III with 16 eyes (7.9%) and 44 eyes (21.9%), respectively, after more than 1-year follow-up. In multivariate regression analysis, lower birth weight (BW), severity of ROP and repeated injections were found to be risk factors for peripheral avascular area (P<0.05). CONCLUSION: In our retrospective study, 29.8% of the ROP eyes treated with ranibizumab have peripheral avascular area at the last follow-up. Lighter BW and the severity of ROP are risk factors. Furthermore, repeated injections also increase the risk of retinal peripheral avascular area remaining in ROP patients.

16 The clinical features of posterior scleritis with serous retinal detachment: a retrospective clinical analysis

Zhi-Zhang Dong , Yi-Feng Gan , Yi-Nan Zhang , Yu Zhang , Juan Li , Hai-Hua Zheng

2019, 12(7):1151-1157. DOI: 10.18240/ijo.2019.07.16

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Abstract:
AIM: To summarize the clinical features, systemic associations, risk factors and choroidal thickness (CT) changing in posterior scleritis (PS) with serous retinal detachment. METHODS: This retrospective study included 23 patients diagnosed PS with retinal detachment from August 2012 to July 2017. All patients’ medical history and clinical features were recorded. The examinations included best corrected visual acuity (BCVA), intraocular pressure (IOP), fundus examination, and routine eye examinations. Posterior coats thickness (PCT) was determined by B-scan ultrasound, the CT was measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) and clinical data were compiled and analyzed. RESULTS: After application of extensive exclusion criteria, 23 patients with PS remained (13 females, 10 males). The average age at presentation was 29.5±9.24 years old. Ocular pain and blurred vision were the two most common complained symptoms by patients. Anterior scleritis occurred in 12 patients, which was confirmed by ultrasound biomicroscopy (UBM) examination. Despite all patients displaying serous retinal detachment in their macula, no fluorescein leakage was observed in the macular area. Optic disc swelling was documented in 10 of the 23 eyes. From B-scan ultrasound examination, the PCT increased with fluid in Tenon’s capsule demonstrated as a typical T-sign. The average PCT was 2.51±0.81 mm in the PS-affected eyes and only 1.09±0.29 mm in the unaffected eye (P<0.0001). The subfoveal CT was 442.61±55.61 μm, which correlated with axis length (r=-0.65, P=0.001) and PCT (r=0.783, P<0.001). The BCVA and IOP did not correlate with either CT or PCT. CONCLUSION: PS with serous retinal detachment presented a variety of symptoms, such as pain, visual loss, and physical indicators. Typical T-sign detected by B-scan ultrasound is a useful confirmatory sign for PS diagnosis. Pathological increases in CT might be a potential predictive factor for inflammation.

17 Artificial intelligence on diabetic retinopathy diagnosis: an automatic classification method based on grey level co-occurrence matrix and naive Bayesian model

Kai Cao , Jie Xu , Wei-Qi Zhao

2019, 12(7):1158-1162. DOI: 10.18240/ijo.2019.07.17

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Abstract:
AIM: To develop an automatic tool on screening diabetic retinopathy (DR) from diabetic patients. METHODS: We extracted textures from eye fundus images of each diabetes subject using grey level co-occurrence matrix method and trained a Bayesian model based on these textures. The receiver operating characteristic (ROC) curve was used to estimate the sensitivity and specificity of the Bayesian model. RESULTS: A total of 1000 eyes fundus images from diabetic patients in which 298 eyes were diagnosed as DR by two ophthalmologists. The Bayesian model was trained using four extracted textures including contrast, entropy, angular second moment and correlation using a training dataset. The Bayesian model achieved a sensitivity of 0.949 and a specificity of 0.928 in the validation dataset. The area under the ROC curve was 0.938, and the 10-fold cross validation method showed that the average accuracy rate is 93.5%. CONCLUSION: Textures extracted by grey level co-occurrence can be useful information for DR diagnosis, and a trained Bayesian model based on these textures can be an effective tool for DR screening among diabetic patients.

18 Influences of personality characteristics and coping modes on anxiety in primary glaucoma patients

Jie Chen , Ze-Nan Lin , Yan-Ting Tao , Qing-Ning Zhao , Qian Li , Hai Yang , Ping Xu , Jian-Mei Chen , Xi-Quan Ma , Hong-Ping Cui

2019, 12(7):1163-1169. DOI: 10.18240/ijo.2019.07.18

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Abstract:
AIM: To examine the influences of personality characteristics and coping modes on the anxiety of primary glaucoma patients. METHODS: A total of 200 individuals, including 50 with primary angle-closure glaucoma, 60 with primary open angle glaucoma and 90 control participants, filled out the State-Trait Anxiety Inventory, NEO Five-Factor Inventory, and Medical Coping Modes Questionnaire. Sociodemographic information was also collected. Data were analyzed via the Spearman rank correlation test and stepwise regression. RESULTS: The personality and coping variables are predictive and jointly account for a significant amount (45.3%-54.2%) of variance across the two subscales of anxiety measures. Notably, neuroticism seems to be most closely related to anxiety disturbances in glaucoma patients. The level of resignation is positively linked to anxiety scores. CONCLUSION: Some personality factors and coping modes help to predict the process of anxiety disorders in primary glaucoma patients. Recognizing the predictive role of these variables in the patients may further enrich clinical research in glaucoma and help to design more effective interventions involving both ophthalmology and psychiatry.

19 Age factor affects reading acuity and reading speed in attaining text information

Ai-Hong Chen , Nursyairah Mohd Khalid , Noor Halilah Buari

2019, 12(7):1170-1176. DOI: 10.18240/ijo.2019.07.19

[Abstract](1368) [HTML](247) [PDF 483.56 K](598)

Abstract:
AIM: To investigate the effect of age on reading acuity and reading speed in attaining text information in healthy eyes. METHODS: Reading acuity, critical print size, reading speed and maximum reading speed were measured in groups of 40 children (8 to 12 years old), 40 teenagers (13 to 19 years old), 40 young adults (20 to 39 years old), and 40 adults (40 years old and above) using the Buari-Chen Malay Reading Chart [contextual sentences (CS) set and random words (RW) set] in a cross-sectional study design. RESULTS: Reading acuity was significantly improved by 0.04 logMAR for both CS set and RW set from children to teenagers, then gradually worsened from young adults to adults (CS set: 0.06 logMAR; RW set: 0.08 logMAR). Critical print size for children showed a significant improvement in teenagers (CS set: 0.14 logMAR; RW set: 0.07 logMAR), then deteriorated from young adults to adults by 0.09 logMAR only for CS set. Reading speed significantly increased from children to teenagers, [CS set: 46.20 words per minute (wpm); RW set: 42.06 wpm], then stabilized from teenagers to young adults, and significantly reduced from young adults to adults (CS set: 28.58 wpm; RW set: 24.44 wpm). Increment and decrement in maximum reading speed measurement were revealed from children to teenagers (CS set: 39.38 wpm; RW set: 43.38 wpm) and from young adults to adults (CS set: 22.26 wpm; RW set: 26.31 wpm) respectively. CONCLUSION: The reference of age-related findings in term of acuity and speed of reading should be incorporated in clinical practice to enhance reading assessment among healthy eyes population.

20 Intravenous glucocorticoids therapy in the treatment of Graves’ ophthalmopathy: a systematic review and Meta-analysis

Li-Quan Zhao , Dan-Yang Yu , Jin-Wei Cheng

2019, 12(7):1177-1186. DOI: 10.18240/ijo.2019.07.20

[Abstract](1543) [HTML](246) [PDF 1.83 M](628)

Abstract:
AIM: To evaluate the benefit and harms of high-dose intravenous glucocorticoids (IVGC) as first-line treatment for Graves’ ophthalmopathy (GO). METHODS: A systematic review and Meta-analysis of randomized clinical trials (RCTs) comparing IVGC for the treatment of GO, with placebo or other treatments, were conducted. Electronic databases were searched, and standard methodological guidance of Cochrane Handbook for Systematic Reviews of Interventions was used. The primary outcome was overall response, and secondary outcomes included the improvement and change in clinical activity score (CAS), and adverse events. RESULTS: Ten RCTs were included in the Meta-analysis. Low quality evidence (one trial) showed that participants receiving IVGC achieved significantly higher response compared to participants receiving placebo [risk ratio (RR) 7.50, 95% confidence interval (CI) 1.14 to 49.26]. Moderate quality evidence (four trials) support appreciable benefit of IVGC in response compared with oral glucocorticoids (OGC), with of RR being 1.51 (95%CI 1.25 to 1.83). There was low quality evidence (one trial) compatible with appreciable benefit for IVGC plus orbital radiotherapy in response (RR 1.38, 95%CI 1.07 to 1.79), compared with OGC plus orbital radiotherapy. One IVGC versus rituximab trial provided moderate quality evidence suggesting that participants using IVGC achieved significantly lower response compared to participants using rituximab (RR 0.70, 95%CI 0.50 to 0.98). One IVGC versus mycophenolate mofetil (MMF) trial provided moderate quality evidence suggesting that participants using IVGC achieved significantly lower response compared to participants using MMF (RR 0.74, 95%CI 0.63 to 0.88). Very low quality evidence (one trial) showed that participants with dysthyroid optic neuropathy (DON) receiving IVGC were more likely to achieve response compared to participants receiving orbital decompression (RR 3.33, 95%CI 0.51 to 21.89). CONCLUSION: The current evidence is moderate quality, which is sufficient to support IVGC to be as the first-line treatment for moderate-to-severe GO, and the use of rituximab or MMF to be the second-line treatment instead of IVGC. However, the evidence is very low quality, which is insufficient to support the use of IVGC or orbital decompression as the first-line treatment of DON.

21 Prevalence of amblyopia in congenital blepharoptosis: a systematic review and Meta-analysis

Jia-Ying Zhang , Xiao-Wei Zhu , Xia Ding , Ming Lin , Jin Li

2019, 12(7):1187-1193. DOI: 10.18240/ijo.2019.07.21

[Abstract](1967) [HTML](240) [PDF 1.24 M](646)

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AIM: To conduct a systematic review and Meta-analysis of the published literature to evaluate the pooled prevalence rate of amblyopia in patients with congenital ptosis. METHODS: We searched the PubMed, Embase, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Data, and Chongqing VIP databases for studies reporting the prevalence of amblyopia in patients with congenital ptosis. The reference lists of relevant studies were scanned. Heterogeneity of effect sizes across studies was tested. We calculated prevalence ratios to compare prevalence estimates for different causes of amblyopia in patients with congenital ptosis, as well as for different geographical regions, year of publication and sample size in subgroup analyses. A systematic review and Meta-analysis were performed. RESULTS: We identified 29 eligible surveys with a total population of 2436. Prevalence rates of amblyopia ranged from 13.8% to 69%. We noted substantial heterogeneity in prevalence estimates for amblyopia in congenital ptosis (Cochran’s χ2 significant at P<0.0001; I2=90%). The pooled prevalence using random-effects models of 29 studies was 32.8% (95%CI: 27.3%-38.4%) in the overall population. Compared to the overall pooled prevalence, amblyopia prevalence was higher in studies in which only subjects with blepharophimosis syndrome were included. CONCLUSION: We confirm that nearly one-third of congenital ptosis patients are suffering from or at risk for amblyopia. Patients with blepharophimosis syndrome are more likely to develop amblyopia. The identification and management of amblyopia should be integral to the treatment of congenital ptosis.

22 A review of paediatric vision screening protocols and guidelines

Uchenna C. Atowa , Samuel O. Wajuihian , Rekha Hansraj

2019, 12(7):1194-1201. DOI: 10.18240/ijo.2019.07.22

[Abstract](1889) [HTML](241) [PDF 294.72 K](740)

Abstract:
Vision screening plays an important role in the early detection of children who have or probably are predisposed to have specific visual problems. The validity and reliability of the screening batteries in relation to the age group to be screened, and the person administering the test as well as the referral and follow-up criteria contribute to the overall outcome of the vision screening. Despite the long history of vision screening and significant improvement in the development of screening protocols, no agreement exists concerning the age at which children should be screened, the exact test batteries that should be included and who should conduct the screening. This review highlights some important aspects of the history of paediatric vision screening and available evidence in support of their use to detect visual conditions in children. It also examines some of the barriers against the development of paediatric vision screening models especially in low and medium income countries.

23 Insights into the pathogenesis of cystoid macular edema: leukostasis and related cytokines

Yoo-Ri Chung , Young Ho Kim , Seung Yeop Lee , Hye-Eun Byeon , Kihwang Lee

2019, 12(7):1202-1208. DOI: 10.18240/ijo.2019.07.23

[Abstract](1533) [HTML](247) [PDF 1.11 M](666)

Abstract:
Cystoid macular edema (CME) is the abnormal collection of intraretinal fluid in the macular region, especially in the inner nuclear and outer plexiform layers. CME leads to severe visual impairment in patients with various retinal diseases, such as diabetic retinopathy, retinal vascular occlusion, choroidal neovascularization, and uveitis. Although various retinal conditions lead to CME, a shared pathogenesis of CME is involved in these diseases. Accordingly, the pathogenesis of CME based on vasogenic mechanisms is first discussed in this review, including vascular hyperpermeability, leukostasis, and inflammation. We then describe cytotoxic mechanisms based on retinal Müller cell dysfunction. This comprehensive review will provide an understanding of the pathogenesis of CME for potential therapeutic strategies.

24 The role of cell mediated immunopathogenesis in thyroid-associated ophthalmopathy

Zhen-Mao Wang , Zheng-Yan Wang , Yan Lu

2019, 12(7):1209-1214. DOI: 10.18240/ijo.2019.07.24

[Abstract](1518) [HTML](231) [PDF 334.86 K](618)

Abstract:
Currently, thyroid-associated ophthalmopathy (TAO) lacks effective treatment due to our lack of clarity in its immunopathogenesis. Orbital fibroblasts play a key role in altering inflammation and immune response in TAO, and are considered as the key target and effector cells in its pathogenesis. The orbit infiltrating CD34+ fibrocytes add on to the process by expressing high levels of autoantigens and inflammatory cytokines, while also differentiating into myofibroblasts or adipocytes. This review focuses on the role of orbital fibroblasts and CD34+ fibrocytes in the pathogenesis of TAO, highlighting the basis of emerging treatments.

25 Intraocular lens implantation performed first to protect the posterior capsule in Morgagnian cataracts during phacoemulsification

Xia Hua , Yongxiao Dong , Ling Wang , Zhiqing Li , Jianying Du , Wei Chi , Xiaoyong Yuan

2019, 12(7):1215-1218. DOI: 10.18240/ijo.2019.07.25

[Abstract](1016) [HTML](234) [PDF 789.75 K](635)

Abstract:
This study evaluated the safety of a modified method to implant an intraocular lens (IOL) into the capsular bag immediately after capsulorhexis with a whole or partial nucleus to protect the posterior capsule (PC) during phacoemulsification in a series of 12 Morgagnian cataracts. For 3 cases of hypermature cataracts with smaller and rigid nuclei, after a complete capsulorhexis, an IOL was directly inserted into the capsular bag, which protected the PC during the subsequent phacoemulsification process in the iris plate. For the other 9 cases with larger and softer nuclei, after the nucleus was partially emulsified, the IOL was inserted into the bag. Even with an obvious surge for some cases, the surgeries were uneventful in all 12 cases, with no PC rent or vitreous loss. IOL implantation into the capsular bag with a whole or partial nucleus can provide effective protection for the PC for hypermature cataract during phacoemulsification.

26 Widefield optical coherence tomography of foveal dragging in retinopathy of prematurity

Victor M. Villegas , Stephen G. Schwartz , Audina M. Berrocal , Timothy G. Murray , Harry W. Flynn Jr.

2019, 12(7):1219-1223. DOI: 10.18240/ijo.2019.07.26

[Abstract](927) [HTML](238) [PDF 1.55 M](558)

Abstract:

27 XEN gel stent: a total delayed-onset postoperative hyphema

Amina Rezkallah , Thibaud Mathis , Philippe Denis , Laurent Kodjikian

2019, 12(7):1224-1226. DOI: 10.18240/ijo.2019.07.27

[Abstract](811) [HTML](236) [PDF 842.85 K](547)

Abstract:

28 Intraocular medulloepithelioma in children: clinicopathologic features itself hardly differentiate it from retinoblastoma

Jinho Lee , Ho-Kyung Choung , Young A Kim , Namju Kim , Sang In Khwarg

2019, 12(7):1227-1230. DOI: 10.18240/ijo.2019.07.28

[Abstract](891) [HTML](236) [PDF 1.59 M](541)

Abstract:

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Volume 12,Issue 7,2019 Table of Contents