Volume 12,Issue 8,2019 Table of Contents

1 Neuroprotective effect of a dietary supplement against glutamate-induced excitotoxicity in retina

Takahiro Kurose , Eriko Sugano , Akihisa Sugai , Raki Shiraiwa , Mariyo Kato , Yoko Mitsuguchi , Yoshihiro Takai , Kitako Tabata , Yoichi Honma , Hiroshi Tomita

2019, 12(8):1231-1237. DOI: 10.18240/ijo.2019.08.01

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Abstract:
AIM: To evaluate the neuroprotective effect of a dietary supplement (ClearVision EX®; CV) against glutamate-induced excitotoxicity in retina. METHODS: We evaluated the protective effects CV on glutamate-induced cell toxicity of an immortalized mouse hippocampal cell line (HT-22) in vitro and N-methyl-D-aspartate (NMDA) induced retinal injury in vivo. Once-daily oral administration of CV or vehicle (5% Arabic gum) was started the day before the NMDA injection and continued until the end of the study. Electroretinograms (ERGs) were recorded to evaluate the retinal function at 2d after NMDA injection. Furthermore, a histological evaluation, Western blot analysis, and immunohistochemistry were performed for assessing the signal transduction pathway. RESULTS: HT-22 cell death was induced by the addition of glutamate and co-incubation with CV protected against it. Oral administration of CV inhibited the decrease in scotopic threshold response amplitudes induced by the intravitreal injection of NMDA and those of the thickness of the inner retinal layer in the histological evaluation. The increased phosphorylated levels of extracellular signal-regulated kinase (ERK) but not cAMP response element binding protein (CREB) or Akt were observed 1h after NMDA injection in both the vehicle- and CV-treated rats; however, pERK activation was no more upregulated at 3h after NMDA injection. pERK upregulation was observed in Müller cells. CONCLUSION: CV shows a protective effect against both glutamate-induced HT-22 cell death and NMDA-induced retinal damage. pERK upregulation in the Müller cells plays a key role in the protective effect of CV against glutamate-induced retinal toxicity.

2 Immunohistochemical features of carcinoma ex pleomorphic adenoma and pleomorphic adenoma in the lacrimal gland

Ping Zhang , Li-Juan Tang , Huan-Huan Gao , Wen-Xin Zhang , Jian-Xian Lin , Hua-Sheng Yang

2019, 12(8):1238-1242. DOI: 10.18240/ijo.2019.08.02

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Abstract:
AIM: To investigate C-myc, Ki-67, pan-cytokeratin, and vimentin immunohistochemical features of carcinoma ex pleomorphic adenoma (Ca-ex-PA) and pleomorphic adenoma (PA) in the lacrimal gland in order to find some clues in the differential diagnosis between them. METHODS: We reviewed microscopic slides and clinical records of 64 cases of PA and 15 cases of Ca-ex-PA in the lacrimal gland. Immunohistochemical antibodies for C-myc, Ki-67, pan-cytokeratin, and vimentin were employed. RESULTS: Median age of PA was 43.2y (from 21 to 75). The 35 patients (54.7%) were male and 29 patients (45.3%) were female. For the PAs, the average positivity of C-myc was 4.6%; the average proliferation index of Ki-67 was 3.2%; pan-cytokeratin was positive in ductal cells, and vimentin was positive in myoepithelial cells. Median age of Ca-ex-PA was 54.3y (from 26 to 76). There were 7 male patients (46.7%) and 8 female patients (53.3%). Among 15 Ca-ex-PAs, there were 6 myoepithelial carcinomas, 4 adenocarcinomas, 3 epithelial-myoepithelial carcinomas, and 2 squamous cell carcinomas. For the Ca-ex-PAs, the average positivity of C-myc was 36.4%; the average proliferation index of Ki-67 was 29.2%; pan-cytokeratin was positive in all cases, and vimentin was positive in myoepithelial carcinomas. CONCLUSION: PA has a lower positivity of C-myc and Ki-67, while Ca-ex-PA had a higher positivity of these two biomarkers. These four biomarkers as a set could provide valuable clues in the differential diagnosis between Ca-ex-PA and PA. Our results indicate that the activation of C-myc could play an important role in the pathogenesis of Ca-ex-PA and PA.

3 Activation of the TRAAK two-pore domain potassium channels in rd1 mice protects photoreceptor cells from apoptosis

Lei Wang , Kang-Pei Shi , Han Li , Hao Huang , Wen-Bin Wu , Chu-Sheng Cai , Xiao-Tong Zhang , Xiao-Bo Zhu

2019, 12(8):1243-1249. DOI: 10.18240/ijo.2019.08.03

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Abstract:
AIM: To investigate the expression of TWIK-related arachidonic acid-stimulated K+ channel (TRAAK) in retinal degeneration mice (rd1) and further evaluate how TRAAK affect photoreceptor cell apoptosis. METHODS: The rd1 mice were distributed into blank (no treatment), control (1.4% DMSO, intraperitoneal injection) and riluzole groups (4 mg/kg·d, intraperitoneal injection) from postnatal 7d to 10, 14 and 18d; C57 group (no treatment), as age-matched wild-type control. The thickness of the outer nuclear layer (ONL) of retina was detected by paraffin section hematoxylin and eosin staining. The expression of TRAAK and the apoptosis of the ONL cells were detected by immunostaining, Western blotting, and real-time polymerase chain reaction. RESULTS: The channel agonist riluzole activated TRAAK and delayed the apoptosis of photoreceptor cells in ONL layer of rd1 mice. Both at mRNA and protein levels, after riluzole treatment, TRAAK expression was significantly upregulated, when compared with the control and blank group. Then we detected a series of apoptosis related mRNA and protein. The anti-apoptotic factor Bcl-2 downregulated and the pro-apoptotic factors Bax and cleaved-caspase-3 upregulated significantly. CONCLUSION: Riluzole elevates the expression of TRAAK and inhibits the development of apoptosis. Activation of TRAAK may have some potential effects to put off photoreceptor apoptosis.

4 Establishment of an adult zebrafish model of retinal neurodegeneration induced by NMDA

Zhi-Wen Luo , Han-Tsing Wang , Ning Wang , Wei-Wei Sheng , Ming Jin , Ye Lu , Yi-Jiang Bai , Su-Qi Zou , Yu-Lian Pang , Hong Xu , Xu Zhang

2019, 12(8):1250-1261. DOI: 10.18240/ijo.2019.08.04

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Abstract:
AIM: To establish a model of retinal neurodegeneration induced by N-Methyl-D-aspartic acid (NMDA) in adult zebrafish. METHODS: We compared the effects of three different NMDA delivery methods on retinal neurodegeneration in adult zebrafish: immersion (I.M.), intravitreal injection (I.V.), and intraperitoneal injection (I.P.), and examined retinal pathology and degeneration by hematoxylin and eosin and TUNEL staining in the treated zebrafish. Effects of the NMDA receptor antagonist MK-801 and the natural product resveratrol on NMDA-induced retinal neurodegeneration were also assessed. RESULTS: The thickened inner retina was seen in histology with 100 μmol/L NMDA by I.M. administration. Significant apoptosis in the retinal ganglion cell layer and retinal thickness reduction occurred in 0.5 mol/L NMDA I.P. administration group.Seizure-like behavioral changes, but no retinal histological alteration occurred in 16 mg/kg NMDA I.P. administration group. Resveratrol and MK-801 prevented NMDA-induced retinal neurodegeneration in the zebrafish. CONCLUSION: Among the three drug administration methods, I.V. injection of NMDA is the most suitable for establishment of an acute retinal damage model in zebrafish. I.M. with NMDA is likely the best for use as a chronic retinal damage model. I.P. treatment with NMDA causes brain damage. Resveratrol and MK801 may be a clinically valuable treatment for retinal neurodegeneration.

5 Protective effects of lipoic acid-niacin dimers against blue light-induced oxidative damage to retinal pigment epithelium cells

Xiu-Lan Zou , Yong-Zhen Yu , Hong-Hua Yu , Guan-Feng Wang , Rong-Biao Pi , Zhe Xu , Chu Zhang , Wen-Jie Zhou , Dan-Dan Li , Xuan-Ge Chen , Yu-Ping Zou

2019, 12(8):1262-1271. DOI: 10.18240/ijo.2019.08.05

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Abstract:
AIM: To evaluate the protective effects of lipoic acid-niacin (N2L) dimers against blue light (BL)-induced oxidative damage to human retinal pigment epithelium (hRPE) cells in vitro. METHODS: hRPE cells were divided into a control group (CG), a BL group, an N2L plus BL irradiation group, an α-lipoic acid (ALA) plus BL group, an ALA-only group, and an N2L-only group. hRPE cellular viability was detected by performing 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium (MTT) bromide assays, and apoptosis was evaluated by annexin-V-PE/7-AAD staining followed by flow cytometry. Ultrastructural changes in subcellular organelles were observed by transmission electron microscopy. Reactive oxygen species formation was assayed by flow cytometry. The expression levels of the apoptosis-related proteins BCL-2 associated X protein (BAX), B-cell leukmia/lymphoma 2 (BCL-2), and caspase-3 were quantified by Western blot analysis. RESULTS: BL exposure with a light density of 4±0.5 mW/cm2 exceeding 6h caused hRPE toxicity, whereas treatment with a high dose of N2L (100 mol/L) or ALA (150 mol/L) maintained cell viability at control levels. BL exposure caused vacuole-like degeneration, mitochondrial swelling, and reduced microvillus formation; however, a high dose of N2L or ALA maintained the ultrastructure of hRPE cells and their organelles. High doses of N2L and ALA also protected hRPE cells from BL-induced apoptosis, which was confirmed by Western blot analysis: BCL-2 expression significantly increased, while BAX and caspase-3 expression slightly decreased compared to the CG. CONCLUSION: High-dose N2L treatment (>100 mol/L) can reduce oxidative damage in degenerating hRPE cells exposed to BL with an efficacy similar to ALA.

6 Dynamic changes of activator protein 1 and collagen I expression in the sclera of myopia guinea pigs

Xin Zhan , Zi-Cheng Zhu , Si-Qin Sun , Yue-Chun Wen

2019, 12(8):1272-1276. DOI: 10.18240/ijo.2019.08.06

[Abstract](1129) [HTML](255) [PDF 619.94 K](561)

Abstract:
AIM: To investigate the dynamic changes of activator protein 1 (AP1) and collagen I expression in the sclera of form-deprivation myopic model in guinea pigs. METHODS: A form-deprivation myopic model in guinea pigs were established with the left eye covered for 2 to 6wk (FDM group). Normal control group (n=25) were untreated. Changes in refractive power and axial length (AL) were measured and recorded at different time points. Expressions of AP1 and collagen 1 of the sclera were measured with Western blotting and reverse transcription-polymerase chain reaction (RT-PCR). The relationship between AP1 and collagen I levels was analyzed. RESULTS: After 0, 2, 4, 6wk, and 4/-1wk of form-deprivation, the diopter in the FDM group was gradually changed (2.08±0.31, -1.23±0.68, -4.17±0.58, -7.07±0.55, and -2.67±0.59 D, respectively, P<0.05), and the AL was gradually increased (5.90±0.38, 6.62±0.37, 7.30±0.35, 7.99±0.31, and 6.97±0.32 mm, respectively, P<0.05). With the prolongation of covered time, the protein expressions of AP1 and collagen I in the FDM group were gradually down-regulated (all P<0.05); the mRNA expressions of them were also gradually down-regulated (all P<0.05); and there was positive correlation between them. The control group had no obvious change in each index (all P>0.05). CONCLUSION: AP1 may be an important transcription factor involved in the regulation of collagen I synthesis and degradation during myopic scleral remodeling.

7 Effects of steep-axis incision on corneal curvature in one-handed phacoemulsification

Pan-Pan Li , Ye-Meng Huang , Qi Cai , Li-Li Huang , Yu Song , Huai-Jin Guan

2019, 12(8):1277-1282. DOI: 10.18240/ijo.2019.08.07

[Abstract](1096) [HTML](260) [PDF 627.79 K](584)

Abstract:
AIM: To examine the effects of one-handed phacoemulsification with steep-axis incision on corneal curvature and analyze surgically induced astigmatism (SIA) on the true net power, anterior and posterior corneal surfaces. METHODS: Patients with cataracts underwent one-handed phacoemulsification with a 2.4-mm steep-axis of clear corneal incision (CCI) based on true net power. CCI was created under the guidance of Verion. Central corneal thickness (CCT), keratometry readings of the true net power and anterior and posterior corneal surface were obtained using Pentacam. Biometry, such as axial length, anterior chamber depth (ACD) and white-to-white (WTW) were performed using Lenstar pre- and 3mo post-operatively. RESULTS: The study evaluated 68 eyes of 65 patients. The mean age was 65.93±9.40y; CCT was 529.21±37.40 μm; WTW was 11.59±0.35 mm. Regarding true net power, keratometric value at the flattest corneal meridian for the 3-mm central zone (Ks) was significantly decreased postoperatively (P=0.031). Keratometric value at the steepest corneal meridian for the 3-mm central zone (Kf) was increased postoperatively (P>0.05). Astigmatism of true net power was 1.21±0.56 D preoperatively and significantly decreased to 1.02±0.58 D postoperatively (P=0.021). On the anterior corneal surface, no significant difference in Ks and Kf was noted pre- versus postoperatively. Anterior corneal astigmatism was 1.08±0.51 D preoperatively and significantly decreased to 0.87±0.46 D postoperatively (P=0.002). On the posterior corneal surface, Ks and Kf were significantly increased postoperatively (all P<0.05), and posterior corneal astigmatism also increased (P=0.008). The SIA values of true net power and the anterior and posterior corneal surfaces at 3mo postoperatively were 1.26±0.63 D (range: 0.11 to 2.80 D), 1.05±0.54 D (range: 0.23 to 2.40 D), and 0.21±0.17 D (range: 0.01 to 0.07 D), respectively. CONCLUSION: One-handed phacoemulsification with steep-axis incision can effectively decrease astigmatism of true net power and anterior corneal astigmatism. In the same surgery, the difference in personal SIA potentially originated from a difference in personal corneal thickness and diameter, both CCT and WTW distance should always be measured preoperatively when planning steep-axis phacoemulsification.

8 Evaluation of suturless scleral fixation with posterior chamber foldable intraocular lens implantation

Ahmed M. Bedda , Hesham F. ElGoweini , Ahmed M. Abdelhadi , Amr M. Elhady

2019, 12(8):1283-1289. DOI: 10.18240/ijo.2019.08.08

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Abstract:
AIM: To assess the sutureless scleral fixation technique for posterior chamber foldable intraocular lens (PCIOL) implantation in aphakic eyes with insufficient or no capsular support. METHODS: A technique for sutureless intrascleral fixation of the haptics of a standard 3-piece PCIOL was used which ensures sutureless fixation by permanent incarceration of the haptics in a scleral tunnel parallel to the limbus. All patients were evaluated for preoperative status [visual acuity, refractive error, K readings, intraocular pressure (IOP) measurement, slit lamp examination, fundus examination and optical biometry], postoperative status and complications. Ultrasound biomicroscopy (UBM) was done for 10 cases to evaluate optic tilt. RESULTS: The study evaluated 42 eyes of 42 patients. The follow-up period was 6mo. Improvement of best corrected visual acuity (BCVA) one line occurred in 10 cases (23.8%) and loss of one line in 3 cases (7.1%). Intraoperative complications included: haptic kink in 4 cases (9.5%), haptic breakage in 1 case (2.4%), haptic dislocation in 1 case (2.4%), haptic slippage in 3 cases (7.1%), IOL dislocation in 1 case (2.4%) and sclerotomy related bleeding in 1 case (2.4%). Postoperative complications included: transient mild vitreous hemorrhage in 3 cases (7.1%), choroidal detachment in 1 case (2.4%), cystoid macular edema (CME) in 1 case (2.4%), optic capture in 1 case (2.4%), subconjunctival haptic in 2 cases (4.8%), ocular hypotony in 4 cases (9.5%) and ocular hypertension in 1 case (2.4%). There were no cases of retinal detachment or endophthalmitis. UBM showed optic tilt in 3 cases (30%). CONCLUSION: Fixation of three-piece foldable IOL haptics in scleral tunnel parallel to the limbus- provided axial stability and proper centration of the IOL with minimal or no tilt in most cases and a low complication rate during the follow up period which lasted 6mo.

9 Ex-PRESS implantation for different types of glaucoma

Meltem Guzin Altinel , Ayse Yagmur Kanra , Remzi Karadag , Huseyin Bayramlar

2019, 12(8):1290-1297. DOI: 10.18240/ijo.2019.08.09

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Abstract:
AIM: To evaluate the clinical results, efficacy and safety of Ex-PRESS P200 glaucoma shunt implant in different types of medically uncontrolled glaucoma. METHODS: The study included 31 eyes of 31 patients that were unresponsive to medical antiglaucomatous therapy in whom Ex-PRESS P200 glaucoma shunt implantation was performed. The demographic characteristics of the patients, type of glaucoma, complete ocular examination results, number of antiglaucomatous drugs before and after surgery, early and late complications of surgery, additional surgical and nonsurgical medical interventions, and success rates were investigated from the patients’ files, retrospectively. RESULTS: The mean postoperative follow-up time was 16.4±7.5mo. The preoperative mean corrected intraocular pressure (IOP) was 28.7±10.3 mm Hg and postoperative mean corrected IOP was 15.3±5.2 mm Hg (P<0.05) at the last visit. The mean IOP reduction was 39.9% when the preoperative and postoperative values of the last visits were compared. The average number of antiglaucomatous drug use decreased from 3.9±0.3 to 1.7±1.7 postoperatively (P<0.05). The use of antiglaucomatous medications at the last visit was more than in other studies in the literature. The most common complication was conjunctival leakage, which was seen in 7 patients. Other early complications were iris touch, intravitreal hemorrhage, hyphema, choroidal effusion, early transient hypotonia and corneal edema. One of the late complications was endophthalmitis which was seen in one case 6mo after the operation, and the other late complication was opacification of the cornea in one patient. Twelve additional surgical operations associated to Ex-PRESS surgery and 3 bleb needling have done. At the last visit, the complete success rate was 32.3% and the qualified success rate was 77.5% in all patients. CONCLUSION: Ex-PRESS P200 glaucoma shunt implantation may be an effective procedure for medically uncontrolled glaucoma with significantly lower use of antiglaucomatous medications.

10 Posterior vitreous detachment rate following intravitreal dexamethasone injection

Atilla Alpay

2019, 12(8):1298-1303. DOI: 10.18240/ijo.2019.08.10

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Abstract:
AIM: To determine whether intravitreal dexamethasone (DEX) implant induces posterior vitreous detachment or not. METHODS: We retrospectively reviewed 810 eyes of 405 patients who underwent intravitreal DEX implantation due to macular edema caused by diabetic and retinal venous occlusion in our clinic. The eyes having no injection were determined as the control group. The examination findings of the patients before the injection and 3mo after the injection and optical coherence tomography (OCT) images were scanned. The pre-injection OCT findings and OCT findings of the patients having no posterior vitreous detachment (PVD) and determined to have partial PVD were compared. RESULTS: The separation in vitreoretinal adhesion and total PVD development of DEX-injected 56/208 (26.9%) eyes were statistically greater in comparison with the 12/129 (9.3%) eyes that had not been injected (P=0.001). PVD development was observed more in the patients that were younger, had larger macula thickness and lower visual acuity. CONCLUSION: It can be stated that intravitreal DEX implant induces PVD development. Prospective, controlled studies are required in order to determine prognosis of vitreoretinal disease in PVD-developed patients and in non-PVD-developed patients.

11 Assessment of optic nerve and optic tract alterations in patients with orbital space-occupying lesions using probabilistic diffusion tractography

Chun-Nan Wu , Shao-Feng Duan , Xue-Tao Mu , Yi Wang , Peng-Yu Lan , Xiao-Lu Wang , Kun-Cheng Li

2019, 12(8):1304-1310. DOI: 10.18240/ijo.2019.08.11

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Abstract:
AIM: To investigate the diffusion changes in both the optic nerve and optic tract in orbital space-occupying lesion patients with decreased visual acuity, and its clinical significance using probabilistic diffusion tractography (PDT). METHODS: Twenty patients with orbital space-occupying lesions and 25 age- and gender-matched healthy persons were included. All patients and controls underwent routine orbital magnetic resonance imaging and diffusion tensor imaging (DTI), using a 3.0T magnetic resonance scanner (Trio Tim Siemens). After the image data were preprocessed, each DTI parameters of the optic nerve and optic tract was obtained by PDT, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). The asymmetry index (AI) of each parameter was calculated. Compared the parameters of the affected side optic nerve and ipsilateral optic tract with the contralateral side by paired sample t-test; compared AI of parameters of optic nerve and optic tract between the patient group and the control group by independent sample t-test. Patients were divided into three subgroups according to the low vision grade standard of WHO, compared the FA and AI of FA between the three subgroups by single factor variance analysis. RESULTS: The affected side optic nerve presented significantly decreased FA, increased MD, AD, and RD values compared to the unaffected side (P<0.05). The AI of FA, MD, AD, and RD of optic nerve in the patients was significantly higher than that of the controls (P<0.05). The comparison results of the optic tract showed that there was no significant difference between the patient group and control group in terms of the bilateral optic tracts in patients (P>0.05). The AIs of the FA value of the optic nerve in the eyesight <0.1 subgroup was significantly higher than that in the other groups (P<0.05). CONCLUSION: FA, MD, AD, and RD of the affected side optic nerve of the orbital space-occupying lesions have significantly changed, the FA value is the most sensitive. The PDT could be a useful tool to provide valid quantitative markers of optic nerve injuries and evaluate the severity of orbital diseases, which other examinations cannot be acquired.

12 Comparison of corneal curvature parameters obtained from two different instruments—Pentacam and VX120

Qing-Wei Zhang , Chang-Bin Zhai , Dong-Li Ma

2019, 12(8):1311-1316. DOI: 10.18240/ijo.2019.08.12

[Abstract](1250) [HTML](249) [PDF 639.56 K](594)

Abstract:
AIM: To explore whether the same corneal curvature parameters and anterior chamber depth measured by Pentacam and VX120 have a good consistency and can replace each other. METHODS: This study enrolled 140 eyes of 70 patients ranging in age from 19 to 53y. All eyes underwent a comprehensive ophthalmologic examination including an anterior segment analysis with the VX120 system (Visionix-Luneau Technologies, Chartres, France) and Pentacam (Oculus Optikgerate GmbH) respectively. The comparison on corneal curvature parameters was done between Pentacam and VX120 using clustered signed rank test; the interclass correlation coefficients (ICC) with 95% confidence intervals (CI) was calculated for each parameter between Pentacam and VX120; the Bland-Altman plot of each parameter was supplemented. RESULTS: The anterior corneal curvature measured by VX120 was Ks: 44.00±1.78 D, KsAt: 89.45±22.18, Kf: 42.84±1.58 D, KfAt: 93.91±79.34; which measured by Pentacam was Ks: 43.80±1.82 D, KsAt: 91.17±21.40, Kf: 42.61±1.64 D, KfAt: 91.16±78.69. There was statistical difference between Pentacam and VX120 for anterior corneal curvature parameter (P<0.001). The posterior corneal curvature measured by VX120 was Ks: -6.42±1.23 D, KsAt: 91.00±23.45, Kf: -5.85±1.24 D, KfAt: 95.93±79.11; which measured by Pentacam was Ks: -6.44±0.32 D, KsAt: 92.24±11.75, Kf: -6.01±1.05 D, KfAt: 74.43±80.64. There was statistical difference between Pentacam and VX120 for posterior corneal curvature parameters (P<0.001). Anterior chamber depth (ACD) measured by Pentacam and VX120 was statistically different. Pentacam and VX120 achieved high consistency only on corneal anterior surface, including Ks and Kf. The ICCs were 0.96 (95%CI: 0.95, 0.97) and 0.95 (95%CI: 0.94, 0.97) respectively. For other corneal surface curvature parameters, all ICCs of between Pentacam and VX120 were below 0.87. Bland-Altman plots indicated of low consistency of corneal surface curvature parameters measured by Pentacam and VX120. CONCLUSION: The corneal curvature parameters and anterior chamber depth measured by Pentacam and VX120 were statistically different. Data measured by Pentacam and VX120 is not suggested to replace each other, mixing data measured by Pentacam and VX120 together is not suggested either.

13 Evaluating correlation between the ocular biometry and genetic variants of MYOC and ABCA1 with primary angle-closure glaucoma in a cohort from northern China

Shao-Lin Wang , Shun-Yu Piao , Man-Yun Xu , Wen Zhang , Jian-Qing Ma , Juan Hao , Hao Chi , Zhong-Qi Xue , Shao-Ping Ha , Wen-Juan Zhuang

2019, 12(8):1317-1322. DOI: 10.18240/ijo.2019.08.13

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Abstract:
AIM: To investigate whether the gene variants in MYOC and ABCA1 are associated with primary angle-closure glaucoma (PACG) and anterior chamber depth (ACD) and axial length (AL) in samples from northern China. METHODS: The present case-control association study consisted of 500 PACG patients and 720 unrelated controls. Each participant was genotyped for eleven single nucleotide polymorphisms (SNPs) in MYOC and ABCA1 genes (rs12076134, rs183532, rs235875 and rs235913 in MYOC, rs2422493, rs2487042, rs2472496, rs2472493, rs2487032, rs2472459 and rs2472519 near ABCA1) using an improved multiplex ligation detection reaction (iMLDR) technique. The genetic association analyses were performed by PLINK using a logistic regression model. The association between genotypes and ocular biometric parameters was performed by SPSS using generalized estimation equation. Bonferroni corrections were implemented and the statistical power was calculated by the Power and Sample Size Calculation. RESULTS: Two SNPs rs183532 and rs235875 as well as a haplotype TTC in MYOC were nominally associated with PACG despite the significance was lost after Bonferroni correction. No association was observed between ABCA1 and PACG, neither did the association between these variants and ACD as well as AL. CONCLUSION: The present study suggests MYOC and ABCA1 do not play a part in the pathogenesis of PACG as well as the regulation of ocular biometric parameters in a northern Chinese population. Further investigations with large sample size are needed to verify this consequence.

14 Increased prevalence of parent ratings of ADHD symptoms among children with bilateral congenital cataracts

Zhuo-Ling Lin , Duo-Ru Lin , Jing-Jing Chen , Jing Li , Xiao-Yan Li , Li-Sha Wang , Zhen-Zhen Liu , Qian-Zhong Cao , Chuan Chen , Yi Zhu , Wei-Rong Chen , Yi-Zhi Liu , Hao-Tian Lin

2019, 12(8):1323-1329. DOI: 10.18240/ijo.2019.08.14

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Abstract:
AIM: To investigate the behavioral and psychological disorders and the prevalence of parent ratings of attention deficit hyperactivity disorder (ADHD) symptoms among children with bilateral congenital cataracts (CCs). METHODS: This cross-sectional study investigated children with bilateral CC aged 3-8y (CC group) using Conners’ Parent Rating Scale-48 (CPRS-48) from July to December 2016. The abnormal rates of psychological symptoms in CC children and normal vision (NV) children were compared using the Chi-square test. The scores of CC children were compared with those of NV children and the Chinese urban norm using the independent samples t-test and one-sample t-test, respectively. RESULTS: A total of 262 valid questionnaires were collected. The ratio of CC children to NV children was 119:143. The overall rate of psychological symptoms in CC children was 2.28 times higher than that in NV children (46.22% vs 20.28%, Pearson’s χ2=20.062; P<0.001). CC children showed higher scores for conduct problems, learning problems, impulsiveness/hyperactivity, anxiety, and hyperactivity index than NV children and the Chinese urban norm, particularly between the ages of 3 and 5y. Furthermore, male children aged between 6 and 8y showed a higher impulsive/hyperactive score than females of the same age (t=6.083, P<0.001). CONCLUSION: Children with bilateral CCs have a higher rate of ADHD symptoms than children with NV. This study provides clinical evidence that screening for psychological symptoms and particularly for ADHD symptoms in children with bilateral CC are recommended for an early diagnosis and timely treatment.

15 Incidence and risk factors of retinopathy of prematurity and utility of the national screening criteria in a tertiary center in Iran

Milad Khorshidifar , Homayoun Nikkhah , Alireza Ramezani , Morteza Entezari , Narsis Daftarian , Hamid Norouzi , Mansoor Shahiari , Mitra Radfar , Ramin Norinia , Saeed Karimi

2019, 12(8):1330-1336. DOI: 10.18240/ijo.2019.08.15

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Abstract:
AIM: To determine the incidence and risk factors of retinopathy of prematurity (ROP) and the sensitivity of current screening criteria in a tertiary eye center in Tehran, Iran. METHODS: In a cross-sectional observational study, neonates weighing ≤2000 grams at birth or born <34wk gestational age (GA) and all other infants at risk of ROP admitted to the neonatal intensive care unit (NICU) or referred to our ROP clinic were investigated. The incidence of ROP and severe ROP (i.e. patients needing treatment) were determined. The associations between risk factors and the development and severity of ROP were assessed. We also examined the sensitivity of the current national screening guideline in Iran. RESULTS: Among 207 infants, the incidence of ROP and severe ROP was 33.3% and 11.1%, respectively. Mean GA and birth weight (BW) were significantly lower in ROP vs non-ROP infants (29±2wk vs 33±3wk, P<0.001; 1274±489 g vs 1916±550 g, P<0.001, respectively). Univariate analysis displayed significant association between ROP incidence and GA, BW, NICU admission period, blood transfusion, surfactant usage, sepsis, intraventricular hemorrhage and patent ductus arteriosus (P<0.05 for all). BW [relative risk (RR): 0.857 (0.711-0.873), P<0.001], GA [RR: 0.788 (0.711-0.873), P<0.001] and blood transfusion [RR: 1.888 (0.995-3.583), P=0.052] were independent ROP risk factors. The sensitivity of country-specific screening guidelines was 95.7% and 100% for overall and severe ROP detection, respectively. CONCLUSION: ROP incidence is relatively high in Iran. Identifying ROP risk factors results in more accurate screening and reduces the risk of irreversible vision loss. The ROP screening criteria utilized in Iran are efficient at the present time.

16 Atropine 0.01% eye drops slow myopia progression: a systematic review and Meta-analysis

Ying Zhao , Kai Feng , Rui-Bao Liu , Jin-Hua Pan , Lai-Lin Zhang , Zhu-Ping Xu , Xue-Jing Lu

2019, 12(8):1337-1343. DOI: 10.18240/ijo.2019.08.16

[Abstract](2494) [HTML](265) [PDF 2.42 M](877)

Abstract:
AIM: To evaluate the effects of atropine 0.01% on slowing myopia progression. METHODS: We searched for relevant studies in the Cochrane Library, PubMed, Embase, Ovid, CBM, CNKI, VIP and Wan Fang Data in Chinese. A supplementary search was conducted in OpenGrey (System for Information on Grey Literature in Europe), the ISRCTN registry, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) from the dates of inception to June 30, 2018. RESULTS: Seven randomized controlled trials (RCTs) with a total of 1079 subjects were included (505 in the atropine 0.01% group and 574 in the control group). The results showed that the atropine 0.01% group exhibited significantly greater control of axial growth than the control group [MD=-0.12, 95%CI (-0.19, -0.06)]. There was also a statistically significant difference between the atropine 0.01% and control groups in the changes in axial length [MD=-0.14, 95%CI (-0.25, -0.03)], but the quality of evidence was low. There were no significant differences between the atropine 0.01% and control groups in the overall effect with respect to diopter value, change in diopter, distance vision and intraocular pressure [MD=0.08, 95%CI (-0.27, 0.42); MD=0.09, 95%CI (-0.17, 0.36); MD= -0.01, 95%CI (-0.02, 0.00); MD=0.08, 95%CI (-0.56,0.40)]. The sensitivity analysis showed that the conclusion of the Meta-analysis is relatively stable. With respect to adverse events, there were significant differences between the atropine 0.01% and control groups [OR=0.26, 95%CI (0.11, 0.61)]. CONCLUSION: Based on the available evidence, atropine 0.01% eye drops offer benefits in controlling axial growth and safety without causing significant differences in diopter values, distance vision and intraocular pressure.

17 Phacoemulsification in eyes with corneal opacities after deep anterior lamellar keratoplasty

Hui Lin , Juan Zhang , Guo-Zhen Niu , Xin-Yu Huang , Yu-Shan Zhang , Chun-Yu Liu , Chang-Yue Zheng , Yan-Long Bi

2019, 12(8):1344-1347. DOI: 10.18240/ijo.2019.08.17

[Abstract](1047) [HTML](244) [PDF 941.87 K](616)

Abstract:
To evaluate the maneuverability and efficacy of phacoemulsification and intraocular lens (IOL) implantation in eyes with corneal opacities after deep anterior lamellar keratoplasty (DALK), twelve eyes of 12 patients with mild to moderate corneal opacities after DALK and coexisting cataracts were analyzed retrospectively. Phacoemulsification and IOL implantation assisted with anterior capsule staining, as well as non-invasive optical fiber illumination, were performed on all eyes. No intraoperative or postoperative complications were noted. Mean corrected distance visual acuity (logMAR) improved from 1.24±0.17 to 0.73±0.22. Post-phaco intraocular pressure was maintained between 13 to 20 mm Hg in all cases throughout the follow-up period. Mean endothelial cell density decreased from 2258.42±205.94 to 1906.25±174.23 cells/mm2. Phacoemulsification and IOL implantation are safe and valid in eyes with mild to moderate corneal opacities after DALK and coexisting cataracts when assisted with anterior capsule staining and non-invasive optical fiber illumination.

18 Adjustment of IOL power for the second eye based on refractive error of the first-operated eye

Jie Zhang , Xiao-Na Ning , Hong Yan

2019, 12(8):1348-1350. DOI: 10.18240/ijo.2019.08.18

[Abstract](948) [HTML](257) [PDF 383.91 K](568)

Abstract:
This study was to estimate refractive status of the second eye of those undergo bilateral cataract surgery based on the first-operated eye, and to evaluate the refractive error (RE) in the second eye after correcting 50% of the first-operated eye’s error when it exceeded ±0.50 diopter (D). In this prospective study, 80 patients were scheduled for cataract surgery in the second eye, who underwent cataract surgery in first eye 1-3mo previously. The RE of each eye postoperatively was determined according to SRK/T formula. When the first-eye refractive error (FERE) exceeded ±0.5 D, the intraocular lens (IOL) power of the second eye was adjusted 50% of the FERE. The second-eye refractive error (SERE) was measured 1mo after surgery. The FERE exceeded -0.50 D in 12 eyes (-0.675±0.16 D), and the adjusted SERE was -0.322±0.73 D (P<0.05). The FERE exceeded +0.50 D in 8 eyes (1.533±1.14 D), and the adjusted SERE was 0.168±1.36 D (P<0.05). The unadjusted SERE in 60 cases remained -0.38 to 0.42 D when the FERE within ±0.05 D. This prospective study confirmed that the prediction of the second eye could be improved by correcting 50% of FERE when this error exceeded ±0.50 D.

19 Effect of individualized therapy for AIDS patients with cytomegalovirus retinitis in intravitreal ganciclovir injections

Lian-Yong Xie , Chao Chen , Wen-Jun Kong , Kui-Fang Du , Chun-Gang Guo , Hong-Wei Dong , Wen-Bin Wei

2019, 12(8):1351-1355. DOI: 10.18240/ijo.2019.08.19

[Abstract](1213) [HTML](251) [PDF 837.14 K](603)

Abstract:
The effect of intravitreal ganciclovir injection combined with intravenous infusion on acquired immune deficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR) was investigated. A total of 32 eyes in 23 AIDS patients diagnosed as CMVR from 2017 to 2018 were included in the retrospective study. All patients underwent induction therapy by using intravenous drip of the anti-cytomegalovirus (CMV) agent ganciclovir (5 mg/kg q12h) combined with intravitreal ganciclovir injection (3 mg/time, 2 times/wk). The visual acuity, fundus photographs, lesion location, and number of intravitreal injections were observed preoperatively and postoperatively. Totally 14 eyes were cured during induction therapy. The number of injections [4.13 (2 to 6)] in CMVR patients with peripherally fundus lesions were significantly lower than those with central lesions [4.89 (2 to 6)]. The individualized therapy of intravitreal ganciclovir injections for AIDS patients with CMVR can effectively reduce the numbers of intravitreal injections.

20 Anterior capsule contraction syndrome: a successful multimodal therapeutic approach

Lisa Toto , Pasquale Viggiano , Luca Vecchiarino , Federica Evangelista , Enrico Borrelli , Leonardo Mastropasqua

2019, 12(8):1356-1358. DOI: 10.18240/ijo.2019.08.20

[Abstract](954) [HTML](248) [PDF 973.86 K](588)

Abstract:

21 Myeloid sarcoma of the eyelid mimicking pre-septal cellulitis in acute myeloid leukemia

Jungyul Park , Hyeshin Jeon , Hee-Young Choi

2019, 12(8):1359-1361. DOI: 10.18240/ijo.2019.08.21

[Abstract](837) [HTML](232) [PDF 1.23 M](589)

Abstract:

22 Central retinal artery occlusion after uneventful glaucoma valve implantation surgery with retrobulbar anesthesia: a case report

Fang-Yu Lin , Ming-Shui Fu

2019, 12(8):1362-1365. DOI: 10.18240/ijo.2019.08.22

[Abstract](932) [HTML](246) [PDF 998.55 K](597)

Abstract:

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

Dan Călugăru , Mihai Călugăru

2019, 12(8):1366-1368. DOI: 10.18240/ijo.2019.08.23

[Abstract](1045) [HTML](246) [PDF 308.12 K](590)

Abstract:

24 Comment on “Two-stage procedure in the management of selected cases of keratoconus: clear lens extraction with aspherical IOL implantation followed by WFG-PRK”

Maddalena De Bernardo , Giulia Abbinante , Giovanni Cembalo , Nicola Rosa

2019, 12(8):1369-1370. DOI: 10.18240/ijo.2019.08.24

[Abstract](759) [HTML](250) [PDF 271.51 K](510)

Abstract:

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Volume 12,Issue 8,2019 Table of Contents