Volume 13,Issue 3,2020 Table of Contents

1 LRG1 promotes corneal angiogenesis and lymphangiogenesis in a corneal alkali burn mouse model

Shan Song , Jun Cheng , Bing-Jie Yu , Li Zhou , Hai-Feng Xu , Ling-Ling Yang

2020, 13(3):365-373. DOI: 10.18240/ijo.2020.03.01

[Abstract](2049) [HTML](0) [PDF 3.46 M](924)

Abstract:
AIM: To investigate the potential effect and mechanism of leucine-rich α-2-glycoprotein-1 (LRG1) on corneal angiogenesis and lymphangiogenesis. METHODS: Corneal neovascularization and lymphatics were induced by establishing alkali burn mouse model. Immunofluorescence staining was performed to detect the location of LRG1 in cornea tissues and to verify the source of LRG1-positive cells. Corneal whole-mount staining for CD31 (a panendothelial cell marker) and lymphatic endothelial hyluronan receptor-1 (LYVE-1; lymphatic marker) was performed to detect the growth of blood and lymphatic vessels after local application of exogenous LRG1 protein or LRG1 siRNA. In addition, expressions of the proangiogenic vascular endothelial growth factor (VEGF) related proteins were detected using Western blot analysis. RESULTS: LRG1 was dramatically increased in alkali burned corneal stroma in both the limbal and central areas. LRG1-positive cells in the corneal stroma were mainly derived from Vimentin-positive cells. Local application of exogenous LRG1 protein not only aggravated angiogenesis but also lymphangiogenesis significantly (P<0.01). LRG1 group upregulated the levels of VEGF and the vascular endothelial growth factor receptor (VEGFR) family when compared with the phosphate-buffered saline (PBS) control group. We also found that LRG1-specific siRNA could suppress corneal angiogenesis and lymphangiogenesis when compared with the scramble siRNA-treated group (P<0.01). CONCLUSION: LRG1 can facilitate corneal angiogenesis and lymphangiogenesis through heightening the stromal expression of VEGF-A, B, C, D and VEGFR-1, 2, 3; LRG1-specific siRNA can suppress corneal angiogenesis and lymphangiogenesis in corneal alkali burn mice.

2 Association of IGF1R polymorphisms (rs1546713) with susceptibility to age-related cataract in a Han Chinese population

Yi-Lei Cui , Xiao-Ning Yu , Xin Zhang , Ye-Lei Tang , Xia-Jing Tang , Hao Yang , Xi-Yuan Ping , Jing Wu , Qi-Chuan Yin , Jia-Yue Zhou , Xia-Yan Xu , Xing-Chao Shentu

2020, 13(3):374-381. DOI: 10.18240/ijo.2020.03.02

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Abstract:
AIM: To explore the susceptible association between the insulin-like growth factor-1 receptor (IGF1R) single nucleotide polymorphism (SNP) and age-related cataract (ARC), and investigate the underlying mechanisms in human lens epithelium (HLE) cells. METHODS: Totally 1190 unrelated participants, comprising 690 ARC patients and 500 healthy individuals in Han Chinese population were recruited and genotyped for target SNP. The χ2-test was used to detect genotypic distribution between the patient and control groups and the logistic regression was performed to adjust the age and gender. Meanwhile, different biological experimental methods, such as cell counting kit 8 (CCK-8) assay, flow cytometry, quantitative real time polymerase chain reaction (Q-PCR) and Western blot, were used to detect cell viability, cell cycle progression and apoptosis in HLE cells or IGF1R knockdown HLE cells. RESULTS: The rs1546713 in IGF1R gene was identified (P=0.046, OR: 1.606, 95%CI: 1.245-2.071), which shown a significant relevance with ARC risk under the dominant model. The results demonstrated that IGF1R knockdown inhibited cell proliferation by inducing cell cycle arrested at S phase and promoting apoptosis. Mechanistically, the cell cycle blocked at S phase was linked with the alterations of cyclin A, cyclin B, cyclin E and P21. The pro-apoptosis function of IGF1R may related with stimulating the activation of Caspase-3 and altering the expression levels of apoptotic proteins, including Bcl-2, Bax and Caspase-3. CONCLUSION: This study first report that IGF1R polymorphisms may affect susceptibility to ARCs in Han Chinese population and provide new clues to understand the pathogenic mechanism of ARCs. Notably, IGF1R is likely a potential target for ARC prevention and treatment.

3 Complement factor B knockdown by short hairpin RNA inhibits laser-induced choroidal neovascularization in rats

Xin Wang , Qing-Li Shang , Jing-Xue Ma , Shu-Xia Liu , Cai-Xia Wang , Cheng Ma

2020, 13(3):382-389. DOI: 10.18240/ijo.2020.03.03

[Abstract](1158) [HTML](0) [PDF 2.13 M](584)

Abstract:
AIM: To evaluate whether recombinant complement factor B (CFB) short hairpin RNA (shRNA) reduces laser-induced choroidal neovascularization (CNV) in rats. METHODS: Laser-induced rat CNV model was established, and then the animals underwent fundus fluorescence angiography (FFA) and hematoxylin and eosin (HE) staining. On day 3 and 7 after photocoagulation, the expression of CFB and membrane attack complex (MAC) was detected by immunhischemistry. A recombinant CFB-shRNA plasmid was constructed. CFB and scrambled shRNA plasmids were intravenous injected into rats via the tail vein on the day of laser treatment, respectively. On day 7, the incidence of CNV was determined by FFA, and the expression of CFB and vascular endothelial growth factor (VEGF) in retinal pigment epithelium (RPE)/choroidal tissues was detected by immunhischemistry, Western blot and/or semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) in CFB and scrambled shRNA groups. The possible adverse effects of CFB-shRNA injection were assessed by transmission electron microscopy and electroretinography. RESULTS: FFA and HE results indicated that a laser-induced rat CNV model was successfully established on day 7 after photocoagulation. The expression of CFB and MAC was extremely weak in normal retina and choroid, and increased on day 3 after photocoagulation. However, it started to reduce on day 7. CFB shRNA plasmid was successfully constructed and induced CFB knockdown in the retinal and choroidal tissues. FFA showed CFB knockdown significantly inhibited incidence of CNV in rats. Moreover, CFB knockdown significantly inhibited the expression of VEGF in RPE/choroidal tissues. CFB shRNA caused no obvious side effects in eyes. CONCLUSION: CFB knockdown significantly inhibits the formation and development of CNV in vivo through reducing the expression of VEGF, which is a potential therapy target. The alternative pathway of complement activation plays an important role in CNV formation.

4 Quantitative analysis by reversed-phase high-performance liquid chromatography and retinal neuroprotection after topical administration of moxonidine

Qian Zhang , Mei-Fang Chu , Yan-Hong Li , Chun-Hua Li , Run-Jia Lei , Si-Cen Wang , Bao-Jun Xiao , Jian-Gang Yang

2020, 13(3):390-398. DOI: 10.18240/ijo.2020.03.04

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Abstract:
AIM: To determine moxonidine in aqueous humor and iris-ciliary body by reversed-phase high performance liquid chromatography (RP-HPLC), and to evaluate the retinal neuroprotective effect after topical administration with moxonidine in a high intraocular pressure (IOP) model. METHODS: The eyes of albino rabbits were administered topically and ipsilaterally with 0.2% moxonidine. A RP-HPLC method was employed for the identification and quantification of moxonidine between 2 and 480min, which presented in the aqueous humor and iris-ciliary body. Flash electroretinography (F-ERG) amplitude and superoxide dismutase (SOD) level were measured between day 1 and day 15 after topical administration with moxonidine in a rabbit model of high IOP. Histological and ultrastructural observation underwent to analyze the changes of retinal morphology, the inner retinal layers (IRL) thickness, and retinal ganglion cell (RGC) counting. RESULTS: Moxonidine was detectable between 2 and 480min after administration, and the peak concentration developed both in the two tissues at 30min, 0.51 μg/mL in aqueous humor and 1.03 μg/g in iris-ciliary body. In comparison to control, F-ERG b-wave amplitude in moxonidine eyes were significantly differences between day 3 and day 15 (P<0.01) in the high IOP model; SOD levels were significantly higher at all time-points (P<0.01) with a maximum level of 20.29 U/mgprot at day 15; and RGCs were significantly higher (P<0.05). CONCLUSION: Moxonidine is a viable neuroprotective agent with application to high IOP model. All layers of retina, including RGC layer, retinal nerve fiber layer and INL, are more preserved after moxonidine administration. SOD plays a neuroprotective role in ocular hypertension-mediated RGC death.

5 Noninvasive stiffness assessment of the human lens nucleus in patients with anisometropia using an ultrasound elastography system

Hai-Yan Zhou , Hong Yan , Wei-Jia Yan , Xin-Chuan Wang , Qiao-Ying Li

2020, 13(3):399-405. DOI: 10.18240/ijo.2020.03.05

[Abstract](875) [HTML](0) [PDF 1.75 M](619)

Abstract:
AIM: To investigate the significance of ultrasound elastography for evaluating stiffness of the human lens nucleus in patients with anisometropia. METHODS: A total of 14 patients (28 eyes) with anisometropia were enrolled. The difference in refractive status between two eyes ≥-4.0 diopters (D) and the difference in axial length (AL) of the eyes was ≥3 mm. There were 5 males and 9 females with an average age of 62±3.3y. The test data of the long AL eye of each patient was included in group A (14 eyes), and test data of the eye with relative short AL was included in group B. Lens nuclear stiffness was measured with free-hand qualitative elastography by independent operators. Strain gray scale and color-coded elastography maps were recorded. In each case, three consecutive measurements were performed and strain ratio was used for statistical analysis. Photograph and sectional view of the lens were analyzed and archived by anterior segment image. RESULTS: In the long AL group, the strain rate in the nucleus of the lens was 0.16%±0.08%; in the short AL group, the strain rate in the nucleus of the lens was 0.54%±0.16%. Independent sample t-test analyses showed that the long AL group lens had a significantly smaller nuclear strain rate than the relatively short AL group, P<0.05. CONCLUSION: The relationship between human lens stiffness and different AL is demonstrated by ultrasound elastography. The long AL is associated with lower strain ratio and less resilience of the lens.

6 Traumatic endophthalmitis and the outcome after vitrectomy in young children

Ya-Li Zhou , Yi-Xiao Wang , Teng-Teng Yao , Yuan Yang , Zhao-Yang Wang

2020, 13(3):406-411. DOI: 10.18240/ijo.2020.03.06

[Abstract](1216) [HTML](0) [PDF 398.22 K](590)

Abstract:
AIM: To explore the traumatic endophthalmitis in young children and the outcome of pars plana vitrectomy (PPV). METHODS: Twenty-two eyes of 22 cases of young children consecutive pediatric traumatic endophthalmitis treated and followed up between September 2014 and May 2018 were included. Aqueous humor or vitreous samples were taken for bacterial culture and sensitivity tests. Intravitreal antibiotics (norvancomycin and ceftazidime) injection, combined with 23-gauge PPV, were administered in 22 eyes. Silicone oil (SO; 5000 centistoke) tamponade or perfluoropropane gas (C3F8) was used in all patients. Main outcome measures were best-corrected visual acuity (BCVA) and retinal attachment, the ratio of penetrating injury, and the existence of intraocular foreign body. RESULTS: The mean age of patients was 6.9±2.2 (range, 3-10)y. All injured eyes suffered from penetrating ocular injury with retained intraocular foreign body in one eye. Bacterial culture was positive in only 2 eyes. The mean follow-up time was 21.1±4.7 (range, 12-30)mo. In the primary PPV, intravitreal antibiotics was administrated in all eyes, SO in 18 eyes, and C3F8 in 4 eyes. The secondary operation of SO removal and C3F8 endotamponade was performed in 16 eyes and a second SO endotamponade due to emulsification of the oil and retinal detachment (RD) was operated in 7 eyes underwent 3 to 11.5mo after primary PPV. A third operation was done in 7 eyes. The final intraocular pressure (IOP) was 8.9±1.8 (range, 6.9-11.4) mm Hg. The final BCVAs were 20/200 or better in 5, counting fingers in 2, and light perception to hand movement in 8 eyes. Whose (66.7%) had retinal injury exhibited worse BCVA (P=0.019, Fisher’s exact test). Eyes underwent SO tamponade exhibited worse final BCVA than that with C3F8 in the primary PPV (P=0.026, Fisher’s exact test). CONCLUSION: Traumatic endophthalmitis in children is generally more severe and associated with more complicated surgical procedures. Most patients have retinal injury need multiple operations and the final BCVA is poor. Prevention of ocular trauma, especially in children, is still critical.

7 Pars plana vitrectomy relieves the depression in patients with symptomatic vitreous floaters

Rong-Han Wu , Jun-Hong Jiang , Yi-Fan Gu , Nived Moonasar , Zhong Lin

2020, 13(3):412-416. DOI: 10.18240/ijo.2020.03.07

[Abstract](1208) [HTML](0) [PDF 444.29 K](557)

Abstract:
AIM: To investigate the depressive state among the patients with symptomatic vitreous floaters (SVF), as well as its change after SVF removal via vitrectomy surgery. METHODS: Twenty-eight eyes of 28 patients who underwent 27-gauge pars plana vitrectomy (PPV) for SVF were included. Thirty-nine eyes of 39 age- and gender- matched healthy volunteers without SVF were also recruited as a healthy control. Center for Epidemiologic Studies Depression (CES-D) was used to assess volunteers and patients’ depression (before and 1wk after PPV). RESULTS: The CES-D score was 18.3±8.6 for patients, and was 12.4±6.0 for healthy control (P=0.003). Patients were significantly more likely to be in a depressive state (53.6%, defined as CES-D score ≥16) than the healthy control (20.5%, P=0.005). For patients with SVF, the CES-D score was negatively correlated with their age (rs=-0.42, P=0.025). After PPV, both the CES-D score (11.9±5.4 vs 18.3±8.6, P<0.001) and proportion of depressive state (18.5% vs 53.6%, P=0.005) were significantly decreased. CONCLUSION: This study suggests that symptoms of vitreous floaters have an apparently negative impact on patients’ psychological state. The PPV can effectively relieve the depressive state for patients with SVF.

8 Flicker defined form and RareBit measurements lack in specificity of visual pathways

Justyna Szkudlarek-Wodzińska , Joanna Przezdziecka-Dolyk , Olaf Fuchs , Ziemowit Poznański , Marta Misiuk-Hojlo

2020, 13(3):417-424. DOI: 10.18240/ijo.2020.03.08

[Abstract](422) [HTML](0) [PDF 739.92 K](448)

Abstract:
AIM: To evaluate the different visual pathways represented by the Heidelberg Engineering Perimeter flicker defined form and RareBit (magnocellular and parvocellular respectively) in different age-groups and according to the fatigue. METHODS: Totally 64 eyes of 32 healthy subjects were included in the prospective study. Each participant underwent screening—ophthalmic examination including best-corrected visual acuity, anterior and posterior segment assessment, and visual field examination with Heidelberg Edge Perimetry (HEP)-standard automated perimeter (SAP) 24-2. They were observed for 2y previously to the enrollment. This helped to define that the enrolled patients did not bear the glaucoma-developing potential. During the screening and after two years the HEP had been conducted in the standard protocol 24-2 and RareBit perimetry (RBP) in accordance with the manufacturer’s description. Participants were randomly assigned to the groups: flicker defined form (FDF)-first or RBP-first. This defined from which additional visual field test the participant started. Participants were additionally subdivided to younger and older study groups. The effect of subject variables was explored with Mann-Whitney U-test. Testing for the presence of correlations between parameters was performed using the Spearman Rank Order Correlations and confirmed by the parametric tests. For the influence of additional factors, the Kruskal-Wallis test was performed. RESULTS: The positive correlation between mean deviation (MD) and mean hit rate (MHR) and pattern standard deviation (PSD) and standard deviation of MHR (±MHR) were found in younger study group (P=0.005, r=0.481 and P=0.0074, r=0.465), whereas in the older subgroup no correlation was observed. Additionally, the randomization protocol helped in defining the role of fatigue on the HEP-FDF results. Participant for whom the HEP-FDF was performed after RareBit had significantly worse results than those for whom the HEP-FDF was first. In the younger group, the MHR and ±MHR depend from age in that group (P<0.05, r=0.43 and r=-0.57 respectively) while no age-dependent differences were found in HEP-related parameters. On the contrary in the older group the MD and PSD varies with age (P<0.05, r=0.47 and r= -0.44 respectively) while the RBP parameters remained unchanged. The questionnaire showed that participants preferred RareBit over HEP-FDF in terms of a duration time, comfort, understanding of the test procedures, and ocular pain (P<0.05). CONCLUSION: The influence of patient’s fatigue should be considered during HEP-FDF examination. An overlap hypothesis should be reevaluated after determining of other factors that affect HEP-FDF and RareBit results.

9 High-dose ruthenium-106 plaque therapy for circumscribed choroidal hemangioma: a retrospective study of 25 Chinese patients

Jing Li , En-Zhong Jin , Jian-Hong Liang

2020, 13(3):425-430. DOI: 10.18240/ijo.2020.03.09

[Abstract](1007) [HTML](0) [PDF 889.88 K](541)

Abstract:
AIM: To evaluate the efficacy and safety of ruthenium-106 (106Ru) plaque radiotherapy at a dose (>50 Gy) higher than recommended (29-50 Gy) for treatment of circumscribed choroidal hemangioma (CCH) in Chinese patients. METHODS: This retrospective study included 25 symptomatic CCH patients undergoing 106Ru plaque brachytherapy involving 25 eyes between January 2005 and August 2016. Ophthalmic examination was performed at the baseline and at each post-treatment follow-up visit, using best-corrected visual acuity (BCVA), dilated fundus examination, and B-scan ultrasonography. The primary efficacy outcome measures included the changes in BCVA and hemangioma dimensions at the last followup visit from the baseline. RESULTS: The mean follow-up duration was 28.0±26.6 (range, 12-110)mo. All the hemangiomas were located in the posterior pole except for two involving the fovea. The mean apex dose of 106Ru plaque radiotherapy was 84.4±19.7 Gy. The mean BCVA improved from 41.4±29.3 (0-97) at the baseline to 53.0±33.8 (0-97) ETDRS letters at the last visit (P=0.01). The mean hemangioma height declined from 3.98±0.88 (2.40-5.50) mm to 0.84±1.63 (0-6.47) mm (P≤0.001), and the greatest linear diameter (GLD) reduced from 9.36±2.23 (6.80-15.00) to 7.40±2.45 (0-13.00) mm (P≤0.001). Hemangioma size increased in one (4%) eye with a worsened vision, and subretinal fluid completely resolved in all but one patient (4%). Radiation-related retinopathy was observed in two patients at post-treatment 9 and 11mo, respectively. CONCLUSION: 106Ru plaque brachytherapy at a dose (>50 Gy) higher than recommended (29-50 Gy) is an effective treatment regimen for symptomatic CCH associated with significantly improved visual acuity and a favorable safety profile in Chinese patients.

10 Correlation of the history of stroke and the retinal artery occlusion: a nested case-control study

Yue-Yan Xiao , Wen-Bin Wei , Ya-Xing Wang , Ai-Dong Lu , Shuo-Hua Chen , Lu Song , Shou-Ling Wu

2020, 13(3):431-437. DOI: 10.18240/ijo.2020.03.10

[Abstract](1407) [HTML](0) [PDF 851.01 K](667)

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AIM: To analyze the systemic factors including stroke history related to the retinal artery occlusion (RAO). METHODS: Patients with an exact diagnosis of RAO in the medical database of the Kailuan Corporation were identified as the case group. Five patients without RAO were added for each case from the Kailuan Study and matched for sex and age (age±2) as the control group. The Kailuan Study is a general population-based cohort study in northern China, in which a total of 101 510 individuals (81 110 men) aged 18-98y were recruited to participate in the study. And the participants were bi-annually re-examined. The database of both groups was from Kailuan study of 2010 cohort. All the information, including the demographic characteristics, lifestyle behaviors, medical comorbidities, medical history, family medical history, drug usage, anthropometric measurements, blood pressure measurement, blood sample laboratory assessment, urine tests, and other physical examinations were all collected. A retrospective nested case-control method was used for this study. Conditional multivariate logistic regression was used to analyze the risk factors with SPSS 13.0 software and SAS 9.3 software. RESULTS: A total of 45 patients were included as the case group, and the control group included 225 patients. In the case group, 28 patients (62.2%) had a central retinal artery occlusion (CRAO), and 17 patients (37.8%) had a branch retinal artery occlusion (BRAO). A total of 18 patients (40.0%) had a stroke before the RAO (mean 4.04±3.88y before the RAO), and 31 patients (81.6%) had infarctions or malacia identified by the cranial computed tomography (CT) scans. The basal ganglia and centrum semiovale were the most frequently involved regions. Plaques in the common carotid artery were present in 32 patients (88.9%). Conditional multivariate logistic regression analysis showed that the RAO was found to be associated with the history of stroke (P=0.0023, OR=28.794; 95%CI: 3.322-249.586). CONCLUSION: A history of stroke can significantly increase the incidence of RAO. Exists of plaque in the carotid artery is mean more than its severe stenosis for RAO.

11 Cataract blindness in Hungary

Gábor L. Sándor , Gábor Tóth , Dorottya Szabó , Irén Szalai , Regina Lukács , Anita Pék , Georgina Z. Tóth , András Papp , Zoltán Z. Nagy , Hans Limburg , János Németh

2020, 13(3):438-444. DOI: 10.18240/ijo.2020.03.11

[Abstract](1091) [HTML](0) [PDF 585.84 K](581)

Abstract:
AIM: To estimate the prevalence of blindness and visual impairment resulting from cataract in the population aged ≥50y in Hungary, and to assess the cataract surgical services. METHODS: A rapid assessment of avoidable blindness (RAAB) was conducted. A total of 3523 eligible people were randomly selected and examined. Each participant underwent surgery for cataract was interviewed with regard to the year, place, and costs of the surgery. Participants with obvious cataract were asked why they had not yet undergone surgery (barriers to surgery). RESULTS: An estimated 12 514 people were bilaterally blind; the visual acuity (VA) in 19 293 people was <6/60, and the VA in 73 962 people was <6/18 in the better eye due to cataract. An estimated 77 933 eyes are blind; 98 067 eyes had a VA of <6/60, and an estimated 277 493 eyes had a VA of <6/18 due to cataract. Almost all cataract surgeries were conducted in government hospitals. The age- and sex-adjusted cataract surgical coverage with VA<3/60 in eyes was 90.0%. The rate of good visual outcome after surgery was 79.5%. Ocular comorbidity was the main cause of poor outcome (78.1%), followed by late complications (such as posterior capsule opacification) (17.2%), inadequate optical correction (3.1%), and surgical complications (1.6%). The main barrier to surgery in people with bilateral cataract and VA of <6/60 was ‘need not felt’. CONCLUSION: The prevalence of visual impairment resulting from cataract is slightly higher than expected. The quality of the cataract surgical service seems adequate in Hungary. However, the number of cataract operations per year should continue to increase due to the increasing patient demands and the aging population.

12 Prevalence and risk factors on age-related cataract and surgery in adults over 50 years old in Binhu District, Wuxi, China

Xing Chen , Dan-Ying Zhou , Jian Shen , Yan-Bing Wu , Qing-Zhu Sun , Jian-Min Dong , Jian-Chun Yu

2020, 13(3):445-451. DOI: 10.18240/ijo.2020.03.12

[Abstract](1379) [HTML](0) [PDF 586.50 K](617)

Abstract:
AIM: To investigate the prevalence and risk factors of age-related cataract (ARC), ARC surgery procedures, and postoperative vision results among adults over 50 years old in the Binhu District of Wuxi City, China. METHODS: Thirty basic sampling units were analyzed via a cluster random sampling method. Detailed medical histories were collected and eye examinations were performed. Cataract prevalence and surgical procedures were quantified. RESULTS: Among the 6150 participants, 1421 cataract cases were diagnosed and prevalence was 23.1%. The prevalence of cortical, nuclear, and posterior subcapsular cataracts increased with age (P<0.001). Cataract prevalence was significantly higher among elderly, female, or illiterate individuals and people with hypertension, diabetes, and a history of smoking and drinking (all P<0.05). As participant age increased and education level decreased, the frequency of cataract blindness surgeries gradually decreased, but without statistical significance within groups (P>0.05). The odds ratio of cataract patients who had or did not have cataract surgery was 3.15 (87/28) and the frequency of cataract blindness surgery was 75.7% (87/115). Poor visual outcomes was in 107 eyes (40.7%) after cataract surgery. Poor vision was mostly caused by uncorrected reflective errors (30.9%) and ocular comorbidities (41.1%). The prevalence of cataract surgery complications was 5.7% (15/263). Surgical complications and posterior capsular opacification were avoidable factors facilitating poor vision. CONCLUSION: ARC, especially in females and illiterate individuals, presents a public health problem in this district. Poor visual outcomes after cataract surgery are frequent. High-quality cataract surgeries and treatment of ocular comorbidities are vital.

13 Referral patterns of children with glaucoma and their caretakers in Northern Tanzania

Achim Fieß , Furahini Godfrey , Alexander K. Schuster , Richard Bowman , Heiko Philippin

2020, 13(3):452-457. DOI: 10.18240/ijo.2020.03.13

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Abstract:
AIM: To describe the referral patterns of children with primary childhood glaucoma (PCG) or secondary childhood glaucoma (SCG) and their presenting symptoms in Northern Tanzania. METHODS: A retrospective observational study of children <17y with PCG or SCG who were referred to Kilimanjaro Christian Medical Centre (KCMC) Eye Department between 2000 and 2013 was conducted. Presenting symptoms, age at presentation, place of origin, distance to hospital, type of glaucoma, visual acuity, optic disc appearance (vertical cup-to-disc ratio) and type of referral were described. RESULTS: Seventy patients with PCG and 27 patients with SCG were included in the study. Median age at first presentation was 1y in the PCG group (range 0-16y) and 9y in the SCG group (range 1-15y). In both groups around 87% of the children presented already with low vision (logMAR>0.48, better eye). Most of the children (60%) and their caretakers presented on their own initiative, while 24% were sent by different general health cadres and 16% by eye care professionals. Buphthalmos was the main symptom mentioned as a trigger for presentation. CONCLUSION: The study shows that most of the children presented late resulting in advanced stages of glaucoma at the time of initiation of treatment. The majority attended the referral eye department on their own initiative with buphthalmos being the most commonly described symptom. Awareness creation among caretakers of children, general health and eye care providers, ideally embedded in general child health promotion activities, is needed to increase and accelerate referrals.

14 Identification of an immune-related signature for the prognosis of uveal melanoma

Ying-Zi Li , Ying Huang , Xiang-Yang Deng , Chang-Sen Tu

2020, 13(3):458-465. DOI: 10.18240/ijo.2020.03.14

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AIM: To construct an immune-related prognostic signature (IPS) that can distinguish and predict prognosis in uveal melanoma (UM). METHODS: The transcriptomic data and clinicopathological information of 80 UM patients were extracted from the TCGA database. These patients were randomly assigned to a training and a testing set. RESULTS: Lasso Cox analysis was performed for the prognostic immune-related genes to develop an IPS for UM in the training set. The signature was validated in both the testing set and entire cohort. We confirmed the prognostic value of our IPS in distinct subgroups and found its association with the T stage and basal diameter of the tumor. Tumor Immune Estimation Resource database analysis revealed that the IPS was negatively correlated with the infiltration of neutrophils and dendritic cells, but positively correlated with the infiltration level of CD8+ T cells. In addition, we demonstrated that immune checkpoints containing PD-1, CTLA-4, IDO, and TIGIT were moderately associated with the IPS. CONCLUSION: This is the first study to develop and validate an immune-related signature with the ability of predicting prognosis for UM patients. Further studies are needed to validate its prediction accuracy.

15 [THIS ARTICLE HAS BEEN RETRACTED]Topographic distribution features of the choroidal and retinal nerve fiber layer thickness in Wenzhou school-aged children

Wei-Qin Liu , Dan-Dan Wang , Xiao-Xia Yang , Yan-Yan Pan , Xue Song , Yu-Shan Hou , Chen-Xiao Wang

2020, 13(3):466-473. DOI: 10.18240/ijo.2020.03.15

[Abstract](1323) [HTML](0) [PDF 989.49 K](578)

Abstract:
[THIS ARTICLE HAS BEEN RETRACTED] AIM: To explore the topographic distribution features of choroidal thickness (CT) and retinal nerve fiber layer thickness (RNFLT), and determine the relationship between CT and ocular parameters in school-aged children. METHODS: The healthy school-aged children with low myopia or emmetropia in Wenzhou were recruited for this cross-sectional study. With high-density optical coherence tomography (HD-OCT) combined with MATLAB software, the CT and RNFLT values in the macular area were measured at different locations and compared. Statistical analyses were performed to evaluate the correlation between CT and ophthalmic parameters, such as spherical equivalent (SE) and the axial length (AL). RESULTS: A total of 279 school-aged children with 8.00±1.35 years of mean age (range, 6-10y) were included. The mean AL was 23.66±0.86 mm. The mean CT in CT-C (264.31±48.93 μm) was thicker than that in CT-N1 (249.54±50.52 μm), and the average CT in the parafoveal region was also thicker than that in CT-N2 (235.65±50.63 μm). The subfoveal CT also varied substantially across refractive errors (P<0.001), and those with myopia (250.59±47.01 μm) exhibited a thinner choroid compared with those with emmetropia (278.74±48.06 μm). CT positively correlated with AL (y=11.12x-4.15; R2=0.18), and positively correlated with SE (y=90.07x+17.916; R2=14.2). The average RNFLT was thickest in the peripapillary region (236.35±19.03 μm), the mean RNFLT-S (131.10±15.16 μm) was thicker than the RNFLT-I (128.20±16.59 μm), and the mean RNFLT-T (76.54±11.99 μm) was thicker than the RNFLT-N (64.28±8.55 μm). The variations in the RNFLT between quadrants did differ between those with myopia and emmetropia (P<0.05). CONCLUSION: We establish demographic information for the choroid and RNFLT. These findings provide information that should be considered in future analyses of the CT and RNFLT in OCT studies in school-aged children.

16 Efficacy and safety of 0.0015% tafluprost versus 0.005% latanoprost in primary open angle glaucoma, ocular hypertension: a Meta-analysis

Xi-Ting Yang , Lin Zhao , Li-Jun Wang , Yi Zhang , Ding-Ying Liao , Jian-Ming Wang

2020, 13(3):474-480. DOI: 10.18240/ijo.2020.03.16

[Abstract](1276) [HTML](0) [PDF 1.25 M](624)

Abstract:
AIM: To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of tafluprost 0.0015% eye drops [benzalkonium chloride (BAK) 0.1 mg/mL] compared with that of latanoprost 0.005% eye drops (BAK 0.2 mg/mL) for primary open angle glaucoma (POAG) and ocular hypertension (OHT). METHODS: All the randomized controlled trials (RCTs) about treating POAG and OHT comparing tafluprost and latanoprost were collected by searching PubMed, Embase, Cochrane Library, CNKI and VIP. The outcomes of interest to evaluate the clinical efficacy and adverse effects included IOP and patient-related drop discomfort. RESULTS: Five RCTs involving 888 glaucoma patients were included. The results showed that, 1) at the end of the study, no statistically significant differences were observed in IOP reduction [standard mean difference (SMD) =0.48, 95%CI 0.07 to 0.88, P=0.085] between tafluprost and latanoprost; 2) No statistically significant differences were observed in adverse events of foreign-body sensation [relative risk (RR) =0.62, 95%CI 0.26 to 1.46, P=0.269], eye irritation (RR=1.16, 95%CI 0.49 to 2.75, P=0.744), eye pain (RR=2.000, 95%CI 0.949 to 4.216, P=0.07), iris hyper-pigmentation (RR=0.741, 95%CI 0.235 to 2.334, P=0.61), dry eye (RR=1.154, 95%CI 0.409 to 3.256, P=0.79) and eye pruritus (RR=1.600, 95%CI 0.536 to 4.774, P=0.4) between tafluprost and latanoprost. However, tafluprost showed more reported incidence of conjunctival hyperaemia than latanoprost (RR=2.11, 95%CI 1.24 to 3.59, P=0.006). CONCLUSION: Tafluprost 0.0015% eye drops (BAK 0.1 mg/mL) and latanoprost 0.005% eye drops (BAK 0.2 mg/mL) are comparable in lowering IOP for open angle glaucoma (OAG) and OHT. It does not differ in the incidence of foreign-body sensation, eye irritation, eye pain, iris hyper-pigmentation, dry eye and eye pruritus, but tafluprost shows less ocular tolerability because of more incidence of conjunctival hyperaemia.

17 Outcomes of 4 surgical adjuvants used for internal limiting membrane peeling in macular hole surgery: a systematic review and network Meta-analysis

Xia-Wei Wang , Yan Long , Yang-Shun Gu , Dong-Yu Guo

2020, 13(3):481-487. DOI: 10.18240/ijo.2020.03.17

[Abstract](1177) [HTML](0) [PDF 980.08 K](557)

Abstract:
AIM: To compare the outcomes of four adjuvants used for internal limiting membrane (ILM) peeling in macular hole surgery, including indocyanine green (ICG), brilliant blue G (BBG), triamcinolone (TA) and trypan blue (TB), through systematic review and random-effects Bayesian network Meta-analysis. METHODS: PubMed, Cochrane library databases and Web of Science were searched until August 2018 for clinical trials comparing the above four adjuvants. ORs for postoperative best corrected visual acuity (BCVA) improvement and primary macular hole closure rates were compared between the different adjuvants. RESULTS: Twenty-seven eligible articles were included. For postoperative BCVA improvement, results of BBG-assisted peeling were significantly more favorable than those of ICG (WMD 0.08, 95% credible interval 0.01-0.16) and TA ranked highest. No significant differences were found between any other two groups in postoperative BCVA improvement. For postoperative primary macular hole closure rates, BBG ranked highest. However, no significant differences were shown between any two groups. CONCLUSION: TA and BBG are the optimum adjuvants for achieving postoperative BCVA improvement macular hole surgery with adjuvant-assisted ILM peeling. Among all adjuvants, the use of BBG is associated with the highest postoperative macular hole closure rate.

18 Cosmetic blepharoplasty and dry eye disease: a review of the incidence, clinical manifestations, mechanisms and prevention

Si-Yi Zhang , Yan Yan , Yao Fu

2020, 13(3):488-492. DOI: 10.18240/ijo.2020.03.18

[Abstract](1464) [HTML](0) [PDF 354.21 K](703)

Abstract:
Dry eye disease is a multifactorial disease of the ocular surface and can be caused by a variety of iatrogenic interventions, especially ophthalmic surgical procedures. This article reviews the incidence, clinical manifestations, mechanisms and prevention of dry eye disease caused or worsened by cosmetic blepharoplasty, and focus on how to reduce and prevent the occurrence of postoperative dry eye disease and provide the basis for the selection of operation methods and the rational drug during the perioperative period.

19 Corneal graft melting: a systematic review

Bin-Bin Zhu , Jie Zhou , Jiao Zheng , Yue Zhang , Ting Wan , Xiao-Dan Huang , Lin Lin , Xiu-Ming Jin

2020, 13(3):493-502. DOI: 10.18240/ijo.2020.03.19

[Abstract](1290) [HTML](0) [PDF 624.93 K](665)

Abstract:
Corneal graft melting is a severe complication of keratoplasty. This review is to summarize the incidence, the pathogenesis, the risk factors, the prognosis and the prevention of corneal graft melting after keratoplasty. We systematically searched PubMed, Web of Science and WanFang database to retrieve potentially eligible articles about relevant clinical reports and animal experiments. We read the full texts to identify eligible articles. The selection of studies and data extraction were performed independently by two reviewers. In conclusion, the pathogenesis of corneal graft melting is complicated, and many risk factors are closely related to corneal graft melting. Analysis of pathogenesis and risk factors of corneal graft melting can facilitate the development of targeted therapies to better guide clinical practice.

20 Anterior segment optical coherence tomography-guided transepithelial phototherapeutic keratectomy for scarring of the central cornea following pterygium excision

Sloan W. Rush , Ryan B. Rush

2020, 13(3):503-508. DOI: 10.18240/ijo.2020.03.20

[Abstract](809) [HTML](0) [PDF 3.38 M](557)

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AIM: To report the outcomes of patients undergoing anterior segment optical coherence tomography-guided transepithelial phototherapeutic keratectomy (ASOCT T-PTK) for central corneal scarring after pterygium excision. METHODS: The charts of 11 eyes of 10 patients that underwent ASOCT T-PTK following excision of visual axis-involving pterygia were retrospectively reviewed from a single private practice institution. The visual outcomes and corneal topographic findings were evaluated 4±1mo after pterygium excision and 6±2mo after transepithelial phototherapeutic keratectomy (T-PTK). RESULTS: All 11 eyes tolerated both the pterygium excision and T-PTK procedure well without any significant intraoperative or postoperative complications. Uncorrected distance visual acuity (UDVA) and manifest refraction corrected distance visual acuity (CDVA) improved after pterygium excision (P=0.03 and P=0.05, respectively). The UDVA and CDVA improved further after T-PTK (P=0.004 and P=0.002, respectively). The topographic surface asymmetry index, topographic surface regularity index, and topographic projected visual acuity significantly improved after T-PTK (P=0.0092, P=0.0022, and P=0.0002, respectively). None of the subjects lost any lines of CDVA, developed recurrence of pterygia or required keratoplasty during the postoperative period. CONCLUSION: ASOCT T-PTK can provide excellent visual and anatomic outcomes in patients with central corneal scarring after excision of visual axis-involving pterygia.

21 Effect of brimonidine tartrate on basophil activation in glaucoma patients

Eldar Rosenfeld , Dana Barequet , Gilad Rabina , Sheila Langier , Moshe Lazar , Gabi Shemesh , Shimon Kurtz , Shmuel Kivity

2020, 13(3):509-512. DOI: 10.18240/ijo.2020.03.21

[Abstract](915) [HTML](0) [PDF 552.37 K](525)

Abstract:
AIM: To evaluate the mechanism of which brimonidine tartrate 0.15% causes clinical hypersensitivity. METHODS: A prospective case-control study comparing 8 glaucoma patients with clinical hypersensitivity to brimonidine to a control group consisting 13 healthy volunteers. Blood samples were stimulated with brimonidine 0.15%, timolol 0.5% or brimonidine tartrate/timolol maleate 0.2%/0.5%. Premixed antibodies (CD63/FITC and aIgE/PE) were added for direct staining and whole-blood samples were lysed, ?xed and analyzed by a flow cytometer. The basophil population was defined by high IgE cell expression. Degranulation was identified by the expression of the activation molecule CD63. RESULTS: Basophil activation was not significant when comparing percent of activated basophils of patients and healthy controls after exposure to brimonidine (2.58%, 2.45%, respectively, P=0.72). There was a significant suppression of basophil activation when a combination of brimonidine-timolol (0.87%) was compared to timolol (2.27%; P=0.012) and to brimonidine alone (2.58%; P=0.017). CONCLUSION: The results of our study do not support the hypothesis that brimonidine induces an immediate allergic reaction. Basophil activation was suppressed by the presence of β-blockers in patients hypersensitive to brimonidine and in healthy individuals. This finding indicates that timolol suppress brimonidine drug reaction by a different mechanism.

22 Ruthenium-106 plaque brachytherapy for the treatment of diffuse choroidal hemangioma in Sturge-Weber syndrome

Ying-Ying Yu , Xiao-Xin Li , Jian-Hong Liang

2020, 13(3):513-517. DOI: 10.18240/ijo.2020.03.22

[Abstract](1009) [HTML](0) [PDF 740.72 K](539)

Abstract:
AIM: To evaluate the efficacy of ruthenium-106 plaque brachytherapy for the treatment of diffuse choroidal hemangioma (DCH) in Sturge-Weber syndrome (SWS). METHODS: A total of 8 patients with DCH in SWS managed with plaque brachytherapy were retrospectively included. Patients were treated with ruthenium-106 plaque therapy (median apex dose: 83 Gy) at the thickest tumor region. On follow-up, we recorded the tumor thickness, the best-corrected visual acuity (BCVA), subretinal fluid (SRF) status, and complications following treatment. RESULTS: At a median follow-up of 43mo, tumor regression was observed in all cases, with a complete resolution of SRF and reduction in tumor-thickness. No radiation complications were recorded during the follow up time. CONCLUSION: Ruthenium-106 plaque therapy to the thickest portion of the tumor seems to be a useful treatment in patients with DCH in SWS.

23 Long-term chorioretinal changes following strabismus surgery—possible occult needle penetration

Victor M. Villegas , Stephen G. Schwartz , Craig A. McKeown , Harry W. Flynn Jr

2020, 13(3):518-519. DOI: 10.18240/ijo.2020.03.23

[Abstract](693) [HTML](0) [PDF 885.36 K](563)

Abstract:

24 Ecstasy-induced optic disc swelling and consequent visual loss

Michaela Ramsauer , Stephan Thurau , Siegfried Priglinger , Efstathios Vounotrypidis

2020, 13(3):520-522. DOI: 10.18240/ijo.2020.03.24

[Abstract](779) [HTML](0) [PDF 1.03 M](525)

Abstract:

25 Featuring the Nd:YAG laser capsulotomy in the operating room

Veronique Promelle , Sharon Armarnik , Christopher J Lyons

2020, 13(3):523-524. DOI: 10.18240/ijo.2020.03.25

[Abstract](708) [HTML](0) [PDF 610.12 K](527)

Abstract:

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Volume 13,Issue 3,2020 Table of Contents