Volume 13,Issue 9,2020 Table of Contents

1 All-trans retinoic acid increases ARPE-19 cell apoptosis via activation of reactive oxygen species and endoplasmic reticulum stress pathways

Juan Wu , Zhen-Ya Gao , Dong-Mei Cui , Hong-Hui Li , Jun-Wen Zeng

2020, 13(9):1345-1350. DOI: 10.18240/ijo.2020.09.01

[Abstract](1330) [HTML](0) [PDF 1.81 M](588)

Abstract:
AIM: To explore the apoptosis of ARPE-19 cells after the treatment with different doses of all-trans-retinoic acid (ATRA). METHODS: ARPE-19 cells were used in the in-vitro experiment. Flow cytometry assay was employed to evaluate the level of reactive oxygen species (ROS) and apoptosis. The effects of ATRA (concentrations from 2.5 to 20 μmol/L) on the expression of endoplasmic reticulum stress (ERS) markers in vitro were evaluated by Western blot and real-time quantitative polymerase chain reaction (qRT-PCR) assays. The contribution of ROS and ERS-induced apoptosis in vitro was determined by using N-acetyl-L-cysteine (NAC) and Salubrinal, an antagonist of NAC and ERS, respectively. RESULTS: Flow cytometry showed that ATRA significantly increased ARPE-19 cell apoptosis and ROS levels in each group (F=86.39, P<0.001; F=116.839, P<0.001). Western blot and qRT-PCR revealed that levels of CHOP and BIP were elevated in a concentration-dependent pattern after the cells were incubated with ATRA (2.5-20 μmol/L). The upregulation of VEGF-A and CHOP induced by ATRA could be inhibited by NAC (antioxidant) and Salubrinal (ERS inhibitor) in vitro. CONCLUSION: ATRA induces the apoptosis of ARPE-19 cells via activated ROS and ERS signaling pathways.

2 Preliminary report on screening IGSF3 gene mutation in families with congenital absence of lacrimal puncta and canaliculi

Fei Wang , Hai Tao , Cui Han , Fang Bai , Peng Wang , Xi-Bin Zhou , Li-Hua Wang , Chuan Liu

2020, 13(9):1351-1355. DOI: 10.18240/ijo.2020.09.02

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Abstract:
AIM: To investigate the variation of IGSF3 gene in three families with congenital absence of lacrimal puncta and canaliculi, and to lay a foundation for further research on the pathogenic gene of congenital lacrimal duct agenesis. METHODS: The members of the three families were recruited. The ophthalmologic examinations in details, including slit-lamp biomicroscope, intraocular pressure and fundus examination, etc. were carried out. All patients were checked with paracentesis of puncta membrane and lacrimal duct probing, as well as the computed tomography-dacryocystography (CT-DCG). Peripheral blood of 14 participants (3 normal) from three families were collected, 4 mL each, for genomic DNA extraction, and 11 exon fragments of IGSF3 gene were amplified and sequenced by polymerase chain reaction (PCR) to determine whether there were IGSF3 genetic variation. RESULTS: A total of 14 members from three families were screened for 4 synonymous variants: c.930C>T (p.Pro366=), c.1359T>C (p.Ser709=), c.1797G>A (p.Ser855=), c.1539G>A (p.Ser769=), and 6 missense variants: c.1507G>A (p.Gly759Ser), c.1783T>C (p.Trp851Arg), c.1952G>T (p.Ser 907Ile), c.3120C>G (p.Asp1040Glu), c.3123C>G (p.Asp1041Glu), c.3139_3140insGAC (p.Asp1046_Pro1047insAsp), and the latter three were only found in two patients with absence of lacrimal puncta and canaliculi combined with congenital osseous nasolacrimal canal obstruction from the first family. CONCLUSION: The same IGSF3 gene mutation c.3139_3140insGAC is found in the patients with congenital absence of lacrimal puncta and canaliculi combine with osseous nasolacrimal canal obstruction.

3 Experimental study of trabecular tissue repair for corneal defect in rabbits

Xia Li , Yun Xiao , Xiao-Wei Gao , Yi Liu , Dai-Kun Lei

2020, 13(9):1356-1360. DOI: 10.18240/ijo.2020.09.03

[Abstract](889) [HTML](0) [PDF 1.24 M](601)

Abstract:
AIM: To investigate the mechanism and effect of trabecular tissue repair for corneal defect, and to provide a theoretical basis for its clinical application. METHODS: Trabeculectomy was performed on 40 (80 eyes) of 70 New Zealand white rabbits. Take trabecular tissue for backup. Thirty (30 eyes) corneal defect models were made, trabecular tissue was filled in the corneal defect, and the oblique cross stitch was used to suture the corneal laceration and debridement. Anterior segment image and optical coherence tomography (OCT) were performed at the time 1d, 1wk, 1 and 3mo after the model was made. After the observation, the cornea was taken and stained with trypanosome blue-alizarin red and the pathological tissue was examined. RESULTS: Observation 1wk after surgery, the area of corneal defect was edema, but the corneal curvature was basically normal, and the anterior chamber existed under slit lamp. After 3mo of observation, most corneal defects were repaired in the form of corneal leucoma and corneal macula (73.3%), the filled trabecular tissue gradually became transparent, fused tightly with the corneal tissue, and the corneal curvature was relatively smooth. But in one case, the trabecular planter was partially detached, no serious complications such as corneal laceration occurred after the stitches were removed. CONCLUSION: The trabecular tissue structure is similar to the corneal, and it can be used as a substitute for the corneal tissue defect by providing fiber scaffolds and cell amplification differentiation, and lay a foundation for the second-stage surgical treatment.

4 Acetylcholinesterase inhibition ameliorates retinal neovascularization and glial activation in oxygen-induced retinopathy

Qiu-Ping Liu , Xian Zhang , Ya-Zhou Qin , Jing-Lin Yi , Jing-Ming Li

2020, 13(9):1361-1367. DOI: 10.18240/ijo.2020.09.04

[Abstract](1067) [HTML](0) [PDF 1.97 M](587)

Abstract:
AIM: To investigate whether inhibition of acetylcholinesterase (AChE) by donepezil ameliorate aberrant retinal neovascularization (RNV) and abnormal glial activation in oxygen-induced retinopathy (OIR). METHODS: A mouse model of RNV was induced in postnatal day 7 (P7) mice by exposure to 75% oxygen. Donepezil was administrated to P12 mice by intraperitoneal injection. Expression and localization of AChE in mouse retinas were determined by immunofluorescence. RNV was evaluated by paraffin sectioning and hematoxylin and eosin (HE) staining. Activation of retinal Müller glial cells were examined by immunoblot of glial fibrillary acidic protein (GFAP). rMC-1, a retinal Müller cell line, was used for in vitro study. Expression of hypoxia-induced factor 1α (HIF-1α) and vascular endothelial growth factor (VEGF) were determined by Western-blot analysis, enzyme-linked immunosorbent assay (ELISA) or immunostaining. RESULTS: Aberrant RNV and glial activation was observed after OIR. Of note, retinal AChE was mainly expressed by retinal Müller glial cells and markedly increased in OIR mice. Systemic administration of donepezil significantly reduced RNV and abnormal glial activation in mice with OIR. Moreover, ischemia-induced HIF-1α accumulation and VEGF upregulation in OIR mouse retinas and cultured rMC-1 were significantly inhibited by donepezil intervention. CONCLUSION: AchE is implicated in RNV with OIR. Inhibition of AChE by donepeizl is likely to be a potential therapeutic approach for retinal neovascular diseases.

5 Crosslinked hyaluronic acid with liposomes and crocin for management symptoms of dry eye disease caused by moderate meibomian gland dysfunction

José-María Sánchez-González , Concepción De-Hita-Cantalejo , María Carmen Sánchez-González

2020, 13(9):1368-1373. DOI: 10.18240/ijo.2020.09.05

[Abstract](1598) [HTML](0) [PDF 656.19 K](628)

Abstract:
AIM: To study the effect of uncrosslinked and crosslinked hyaluronic acid combined with other artificial tear components in patients with dry eye caused by moderate meibomian gland dysfunction. METHODS: Prospective, single-blind, contralateral eye study. Fifty eyes (25 patients) were analyzed. Eye selection for each tear type was random, and the eye drop formulations, 0.4% uncrosslinked hyaluronic acid and 0.2% galactoxyloglucan (tear A) and 0.15% crosslinked hyaluronic acid, crocin, and liposomes (tear B) were used. The determined dosing schedule was three times a day for six weeks, and the study participants underwent a clinical examination before and 45d after lubricant treatment. The Schirmer test, tear breakup time (TBUT) test, and Ocular Surface Disease Index (OSDI) questionnaire were applied before and after instillation period with both types of artificial tears. RESULTS: On the Schirmer test, a significant improvement was obtained with both tear A (P<0.01) and tear B (P<0.01). On the TBUT test, a significant improvement was obtained with tear A (P<0.01) and tear B (P<0.01). The OSDI score significantly decreased after instillation period with both artificial tear types (P<0.01). CONCLUSION: Uncrosslinked hyaluronic acid combined with other components, such as tamarind seed polysaccharide, and crosslinked hyaluronic acid combined with liposomes and crocin are effective for management symptoms of dry eye disease.

6 A 5-year analysis of endothelial vs penetrating keratoplasty graft survival in Chinese patients

Anita Lai Wah Li , Rachel Pui Wai Kwok , Ka Wai Kam , Alvin Lerrmann Young

2020, 13(9):1374-1377. DOI: 10.18240/ijo.2020.09.06

[Abstract](941) [HTML](0) [PDF 592.76 K](484)

Abstract:
AIM: To determine if there is any difference in long term graft survival between Descemet’s stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PK). METHODS: A retrospective 5-year cases analysis of bullous keratopathy secondary to Fuchs’ endothelial dystrophy or pseudophakic bullous keratopathy, receiving either DSEK or PK. A total of 42 DSEK cases and 25 PK cases were included in the analysis. RESULTS: In the 5-year analysis, graft survival rates were very similar in the two groups (DSEK 77.1% vs PK 76.0%, P=0.918, 95%CI: -6.3 to 33.4). Sub-analyses at 1y (DSEK 81% vs PK 95%, P=0.085, 95%CI: -29 to 3.6) and 2y (DSEK 81% vs PK 88%, P=0.381, 95%CI: -25.9 to 11.8) show a trend towards lower survival rates of DSEK vs PK, but the results were not statistically significant. CONCLUSION: Long term 5-year graft survival is similar between the DSEK and PK methods of corneal transplant in Chinese patients with bullous keratopathy.

7 Accuracy of eight intraocular lens power calculation formulas for segmented multifocal intraocular lens

Jing Zhao , Liang-Ping Liu , Huan-Huan Cheng , Jian-Bing Li , Xiao-Tong Han , Yu Liu , Ming-Xing Wu

2020, 13(9):1378-1384. DOI: 10.18240/ijo.2020.09.07

[Abstract](1229) [HTML](0) [PDF 414.17 K](563)

Abstract:
AIM: To evaluate the accuracy of eight different intraocular lens (IOL) power calculation formulas for a segmented multifocal IOL. METHODS: A total of 53 eyes of 41 adult cataract patients who underwent phacoemulsification and implantation with the SBL-3 segmented multifocal IOL between January 1, 2017 and January 31, 2019 were included in this retrospective study. Preoperative biometry measurements were obtained using an IOL Master. Manifest refraction was performed at least 4wk postoperatively. Accuracy of the eight formulas [Barrett Universal II, Emmetropia Verifying Optical (EVO), Haigis, Hill-RBF 2.0, Hoffer Q, Holladay 1, Kane, and SRK/T] was analyzed. RESULTS: Using current lens constants, all formulas exhibited errors of slight myopic shift in refractive prediction. The Barrett Universal II formula had a significantly lower median absolute error (MedAE) than did Holladay 1 (P=0.02), Kane (P=0.001) and Hill-RBF 2.0 (P<0.001) formulas. The Haigis formula had a lower MedAE value than did the Hill-RBF 2.0 formula (P=0.005). Differences in MedAE values among SRK/T, EVO and Hoffer Q formulas were not significant. After optimizing lens constants, the MedAE values of all formulas were reduced; significant changes were noted for EVO (P=0.022), Haigis (P=0.048), Hill-RBF 2.0 (P=0.014), Holladay 1 (P=0.045) and Kane (P=0.022) formulas. All formulas performed equally well after optimization of lens constants (P=0.203). CONCLUSION: All eight formulas tend to result in a myopic shift when using current lens constants. Optimized lens constants improve the accuracy of these formulas among adult Chinese patients.

8 Combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation in the treatment of PACG with cataract

Wan-Shu Zhou , Wen-Xiang Lin , Yun-Yun Geng , Tao Wang

2020, 13(9):1385-1390. DOI: 10.18240/ijo.2020.09.08

[Abstract](880) [HTML](0) [PDF 445.00 K](577)

Abstract:
AIM: To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation (PGE group and PG group) for the treatment of patients with coexisting primary angle-closure glaucoma (PACG) and cataracts. METHODS: The clinical data of patients with PACG and cataract were retrospectively reviewed. There was a total of 88 eyes in the study and were divided into two groups, 42 eyes in PGE group and 46 eyes in PG group. Surgery success cumulative survival, preoperative and postoperative intraocular pressure (IOP), number of IOP-lowering medications, best corrected visual acuity (BCVA) in the two groups were observed for more than 12mo and compared within each group and between two groups. RESULTS: The mean IOP in PGE group declined from 24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation (P<0.001) and at the last visit 16.2 mm Hg (P<0.001). Meanwhile PG group also showed significant decrease, from 24.1 mm Hg preoperatively to 13.0 mm Hg at 1mo after operation (P<0.001) and 15.3 mm Hg at the last visit (P=0.004). The mean medications reliance reduced in both groups, in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit (P<0.001), in PG group from 0.87 to 0.10 (P<0.001). At the last visit, BCVA increased from 0.21 to 0.60 in PGE group (P<0.001) and from 0.24 to 0.67 in PG group (P<0.001). The success rate of PGE group at 1mo was 95.2%, then decreased to 70.7% at the last visit, whereas in PG group, the success rate at 1mo was 100%, at the last visit was 73.4%. CONCLUSION: PGE shows promise for PACG patients with cataracts to reduce IOP, lighten the medication burden and improve visual acuity, and PG still has its value in specific patients.

9 Efficacy and safety of high-dose ultrasound cyclo-plasty procedure in refractory glaucoma

He-Ting Liu , Qing Zhang , Zheng-Xuan Jiang , Yu-Xin Xu , Qian-Qian Wan , Li-Ming Tao

2020, 13(9):1391-1396. DOI: 10.18240/ijo.2020.09.09

[Abstract](1003) [HTML](0) [PDF 370.76 K](545)

Abstract:
AIM: To evaluate the efficacy and safety of high-dose ultrasound cyclo-plasty (UCP) for the treatment of refractory glaucoma in Chinese patients. METHODS: In this 6-month retrospective study, 37 eyes of 37 patients suffering from severe glaucoma with uncontrolled intraocular pressure (IOP) of ≥21 mm Hg underwent 8-s ultrasonic cyclocoagulation with ten active piezoelectric elements. A complete ophthalmic examination was performed before and at 1d, 1, 3, 6mo after UCP. Therapeutic success was defined as IOP reduction from baseline ≥20% and IOP ≥5 mm Hg without adding new glaucoma medication compare to baseline at the 6-month follow-up visit. In addition to mean IOP at each follow-up visit, medications used and complications were also detected and compared to baseline. RESULTS: After UCP procedure, the mean IOP was significantly reduced (P<0.01) from the preoperative 44.1±11.9 mm Hg to postoperative 26.7±11.8 mm Hg at 3mo, and 30.4±14.5 mm Hg at 6mo. The overall mean IOP reductions achieved at 3 and 6mo were 39% and 31% compared to baseline IOP. Sixty-one percent of patients responded well to UCP treatment with a mean IOP reduction of 48% at 3mo and 42% at 6mo. Ocular pain in most of patients were alleviated. No serious intraoperative or postoperative complications occurred. CONCLUSION: High-dose UCP treatment is an effective and safe procedure to reduce IOP in Chinese patients with severe glaucoma.

10 Improved thickness measurement method for choroidal hyperpermeability in central serous chorioretinopathy

Xing-Wang Chen , Fang-Yuan Han , Gang Su , Le Pan , Shan-Jun Cai

2020, 13(9):1397-1403. DOI: 10.18240/ijo.2020.09.10

[Abstract](981) [HTML](0) [PDF 1.10 M](570)

Abstract:
AIM: To observe choroidal thickness changes in the choroidal hyperpermeability area (CHA) in patients with central serous chorioretinopathy (CSC) after photodynamic therapy (PDT) using indocyanine green angiography (ICGA) combined with optical coherence tomography (OCT). METHODS: This was a cohort study of 17 eyes (17 patients) with CSC. In all patients, the range of CHA was determined by ICGA. The patients were divided into two groups based on CHA covered the fovea (group A) or not (group B). All patients received half-dose verteporfin PDT over CHA in ICGA. Choroidal thickness was measured by OCT before, 1, and 3mo after treatment. The choroidal thickness values of the fovea and CHAs were obtained for each measurement. Secondary outcomes were changes in the best-corrected visual acuity (BCVA) and amount of subretinal fluid (SRF). RESULTS: The differences in center choroidal thickness at baseline and at 1 and 3mo post-PDT were statistically significant in group A and all patients (both P<0.001). There was no significant difference in group B (P=0.059). The differences of thickness of CHA and BCVA at baseline and 1 and 3mo post-PDT were statistically significant in group A, group B, and all patients (all P<0.01). All patients showed complete SRF absorption at 3mo post-PDT. CONCLUSION: Center choroidal thickness does not accurately reflect changes in CHA of patients whose CHA does not covered the fovea center. Using CHA as the observation target can make up for this limitation, expand the scope of application, and reduce bias.

11 Efficacy of the subthreshold micropulse yellow wavelength laser photostimulation in the treatment of chronic central serous chorioretinopathy

Mehmed Ugur Isik , Mehmet Fatih Kagan Degirmenci , Ayhan Saglik

2020, 13(9):1404-1410. DOI: 10.18240/ijo.2020.09.11

[Abstract](1394) [HTML](0) [PDF 1.20 M](576)

Abstract:
AIM: To evaluate the efficacy and safety of subthreshold micropulse yellow laser (SMYL) in the treatment of chronic central serous chorioretinopathy (CCSC). METHODS: The medical records of 58 eyes of 58 patients with CCSC were reviewed. A 577-nm SMYL system was used for the treatment. Fundus fluorescein angiography was used as the primary method of identifying CCSC, and resolution of subretinal fluid (SRF) evaluated by optical coherence tomography (OCT) and fundus autofluorescence. Central macular thickness (CMT), central macular volume (CMV), total macular volume (TMV), subfoveal choroidal thickness (SFCT), subretinal fluid height (SRFH), and subfoveal fluid basement diameter values were measured by spectral domain-OCT (SD-OCT) for all eyes. RESULTS: The mean age of the patients was 42.4±9.9 (range: 20-72)y. The mean follow-up was 11.4±8.5 (range: 6-37)mo. Median BCVA at at the final follow up after treatment was statistically significant from the baseline. Complete SRF resolution was 12.1% of the eyes in the 1st month, 67.2% of the eyes in the 3rd month and 67.2% of the eyes in the last follow up. The initial median CMT, CMV, TMV, and SFCT values before treatment was significantly higher than 3rd month visit values (P<0.001). In the multivariate analysis performed, age and disease duration were found to be a risk factor for persistent SRF (P=0.017, P=0.016, respectively). CONCLUSION: SMYL treatment provides a significant anatomical and functional improvement and is effective in eliminating SRF in eyes with CCSC.

12 Risk factors for an atherothrombotic event in patients with diabetic macular edema treated with intravitreal injections of bevacizumab

Alon Tiosano , Aviel Hadad , Noam Yanculovic

2020, 13(9):1411-1416. DOI: 10.18240/ijo.2020.09.12

[Abstract](751) [HTML](0) [PDF 499.85 K](553)

Abstract:
AIM: To identify risk factors for an atherothrombotic event (ATE) among patients who were treated for diabetic macular edema (DME) with intravitreal bevacizumab injections. METHODS: This retrospective study enrolled all consecutive patients with DME who were treated by intravitreal bevacizumab from 2009 through 2016 in a single center. They were divided into one group treated by bevacizumab and subsequently had an ATE and a second group also treated by bevacizumab and did not have an ATE. RESULTS: A total of 455 patients with DME were enrolled. Seventy-two of the patients had an ATE. A multivariate model adjusted for age, gender, smoking, body mass index, hemoglobin A1c (HbA1c), duration of diabetes, creatinine, and blood pressure revealed an increased risk for ATE in the patients with diabetic duration of more than 13y, a systolic blood pressure over 153.5 mm Hg at first treatment, or having been treated by more than 4 intravitreal bevacizumab injections. Additionally, patients that had an ATE within 3mo from the last intravitreal treatment underwent more bevacizumab injections (5.2±3.4 vs 3.07±1.86; P<0.001). CONCLUSION: The risk factors for an ATE identified in this study are systolic blood pressure >153.5 mm Hg, a history of diabetic mellitus for more than 13y, and treatment with more than 4 intravitreal bevacizumab injections. These factors need to be borne in mind when bevacizumab is being considered in the management of patients with DME.

13 Vitrectomy with air tamponade for surgical repair of rhegmatogenous retinal detachment by eye position guided fluid-air exchange

Yu-Hong Cheng , Hua Wang , Bo Li , Meng Ji , Qiang Shi , Yun Qi , Ya-Guang Hu , An-Ming Xie , Cheng Pei

2020, 13(9):1417-1422. DOI: 10.18240/ijo.2020.09.13

[Abstract](1135) [HTML](0) [PDF 724.34 K](561)

Abstract:
AIM: To observe the efficacy and safety of pars plana vitrectomy (PPV) with eye position guided fluid-air exchange (FAX) and air tamponade in the treatment of rhegmatogenous retinal detachment (RRD). METHODS: RRD patients without severe proliferative vitreoretinopathy (PVR) C1 or more were enrolled. All patients underwent PPV combining with air tamponade. During operation, the primary retinal break(s) were placed at lower site and subretinal fluid was aspirated through the break(s) at the same time when eye position guided FAX was proceeding. Sufficient laser spots were made to seal the retinal break(s) after FAX, and filtered air was left in vitreous cavity as tamponade agent finally. The main outcomes were primary and final success rates, best corrected visual acuity (BCVA), and the secondary outcomes were rate of postoperative cataract surgery and high intraocular pressure. RESULTS: A total of 37 eyes (20 males and 17 females) with a follow-up time of ≥6mo were included. The range of RRD was 5.6±1.8h, and the number of retinal breaks was 1.9±1.2. The breaks located at inferior quadrants (between 3:00 and 9:00) in 5 cases (13.5%), and both superior and inferior breaks were found in 3 cases (8.1%). A total of 25 cases (67.6%) with macular detached involvement, 9 cases (24.3%) with intraocular lens, and 8 patients (21.6%) were treated with phacoemulsification and intraocular lens implantation together. The success rate of primary retinal reattachment was 100% (37/37). At 6mo postoperatively, BCVA (logMAR) was increased from 1.13±1.07 to 0.23±0.15 (P<0.001). Phacoemulsification combined with intraocular lens implantation was performed in 2 patients (5.4%), and one of them underwent macular epiretinal membrane peeling in addition (2.7%). Furthermore, high intraocular pressure was found in 4 cases (10.8%). CONCLUSION: PPV with air tamponade by eye position guided FAX can achieve a high reattachment success rate in the management of patients with RRD, and it has the advantages of short postoperative prone time and fewer operative complications.

14 Umbilical cord derived mesenchymal stem cell implantation in retinitis pigmentosa: a 6-month follow-up results of a phase 3 trial

Neslihan Sinim Kahraman , Ayse Oner

2020, 13(9):1423-1429. DOI: 10.18240/ijo.2020.09.14

[Abstract](1360) [HTML](0) [PDF 1014.65 K](743)

Abstract:
AIM: To investigate the efficacy and the safety of umbilical cord derived mesenchymal stem cell (UC-MSC) implantation in patients with retinitis pigmentosa (RP). METHODS: This prospective, single-center, phase 3 clinical study enrolled 124 eyes of 82 RP patients. The patients received 5 million UC-MSCs to the suprachoroidal area with a surgical procedure. Patients were evaluated on the 1st day, 1st, and 6th months postoperatively. Best corrected visual acuity (BCVA), anterior segment and fundus examinations, color photography, optical coherence tomography (OCT), and visual ?eld (VF) tests were carried out at each visit. Fundus ?uorescein angiography (FFA) and multifocal electroretinography (mfERG) recordings were performed at the end of the 6th month. Ocular and systemic adverse events of the surgical procedure were also noted. RESULTS: All of the 82 patients completed the 6-month follow-up period. None of them had any serious systemic or ocular complications. There were statistically significant improvements in BCVA and VF during the study (all P<0.05). The amplitudes of the P1 waves in the central areas showed significant improvements in mfERG recordings. There were also significant increases in implicit times of P1 waves in the central areas. CONCLUSION: Suprachoroidal administration of UC-MSCs has beneficial effect on BCVA, VF, and mfERG measurements during the 6-month follow-up period. Cell mediated therapy based on the secretion of growth factors (GFs) seems to be an effective and safe option for degenerative retinal diseases.

15 Choroidal changes in eyes treated with high-dose systemic corticosteroids for optic neuritis

Jun Hyuk Lee , Ji Young Lee , Ho Ra , Nam Yeo Kang , Jiwon Baek

2020, 13(9):1430-1435. DOI: 10.18240/ijo.2020.09.15

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Abstract:
AIM: To analyze the effect of systemic high-dose corticosteroid on the choroid in patients with unilateral optic neuritis. METHODS: A retrospective comparative cohort study. Seventy-six eyes of 38 patients with unilateral optic neuritis that received systemic high-dose corticosteroid treatment were enrolled. Choroidal thickness (CT) and choroidal vascularity index (CVI) were measured in both affected and the fellow eyes at baseline, 1wk, 1 and 3mo. Changes in CT and CVI were analyzed in both eyes and compared between eyes. RESULTS: The mean CT and CVI were 349 μm and 0.70 in the affected eyes and 340 μm and 0.69 in the fellow eyes at baseline (P=0.503 and 0.440, respectively). Decrement of CT and CVI at month 3 were significant in affected eyes (P=0.017 and P<0.001). Decreased CVI began 2wk after treatment whereas CT decreased from 1mo. The CVI also decreased significantly in fellow eyes at 3mo compared to the baseline (P=0.001). CONCLUSION: A significant decrement in CT and CVI can appear after 3mo in optic neuritis patients treated with high-dose systemic corticosteroid treatment. The decrease in CVI appeared earlier than the decrease in CT, suggesting choroidal vasoconstriction caused by systemic steroid as a possible mechanism.

16 A new visual acuity test on touchpad for vision screening in children

Elsa Di Foggia , Noémie Stoll , Hélène Meunier , Adam Rimelé , Pascal Ance , Pierre-Henri Moreau , Claude Speeg-Schatz , Arnaud Sauer

2020, 13(9):1436-1442. DOI: 10.18240/ijo.2020.09.16

[Abstract](1101) [HTML](0) [PDF 500.47 K](658)

Abstract:
AIM: To validate a visual acuity (VA) test application on touchpad in the screening of pediatric population by comparing VA results obtained with conventional tests. METHODS: A cohort of 101 patients, 44 girls and 57 boys with a median of 6.5 years old (3-10 years of age), presenting for eye examinations in Ophthalmology Department (Strasbourg, France) between November 1st, 2018, and February 1st, 2019 were enrolled. Monocular and binocular VA testing was performed on the subject using both a standard test and the touchpad application (Monoyer, “E” or, Pigassou depending of children’s capacities). Patients were excluded if they were physically or mentally unable to use the touchpad. The duration of each tests, the painfulness, the comprehension, the attention of children during the test and test’s preferences were also evaluated. RESULTS: There was a good linear correlation and intra-class correlation coefficient [ICC=0.50 (0.34, 0.64) for binocular acuity, 0.74 (0.64, 0.82) for right eyes and 0.525 (0.37, 0.66) for left eye]. The standard errors of measurement were very low (0.08, 0.05, 0.08 for binocular VA, right eyes VA and left eyes VA, respectively). There was no difference between two tests for right eye (P=0.126), left eye (P=0.098) and binocular acuity (P=0.085). Non inferiority was proved for all binocular [-0.06 (-0.09, -0.03)], right eye [-0.04 (-0.07, -0.01)] and left eye [-0.06 (-0.09, -0.02)] VA. The sensitivity and specificity, which correspond to the ability for our app to detect amblyopia, were 92% and 80% respectively. CONCLUSION: Our touchpad application represents an efficient and valid test of VA in children with a high specificity to detect visual impairment.

17 Anterior segment parameters associated with extramuscular manifestations in polymyositis and dermatomyositis

Zoltan Griger , Katalin Danko , Gabor Nemeth , Ziad Hassan , Zsuzsa Aszalos , Katalin Szabo , Levente Bodoki , Rudolf Gesztelyi , Judit Zsuga , Peter Szodoray , Adam Kemeny-Beke

2020, 13(9):1443-1450. DOI: 10.18240/ijo.2020.09.17

[Abstract](1171) [HTML](0) [PDF 488.47 K](562)

Abstract:
AIM: To evaluate detailed anterior segment parameters of patients with idiopathic inflammatory myopathies (IIM), including polymyositis (PM), and dermatomyositis (DM), and to clarify the associations between these data and clinical variables of IIM. METHODS: Totally 57 PM, 41 DM patients and 62 controls were enrolled in this cross-sectional, observational, case-control study. All study participants underwent Pentacam evaluation. Laboratory investigations consisted of different antibody assays, while extramuscular clinical assessments included Raynaud’s phenomenon, dysphagia, interstitial lung disease, arthritis/arthralgia, and weight loss. Objective signs and subjective symptoms of dry eye disease (DED) were also evaluated. RESULTS: All pachymetric parameters [center, apex, thinnest and maximal keratometry (Kmax)] and corneal volume (CV) of both sides of PM patients proved to be significantly lower. Some pachymetric data were also noticed as significantly decreased compared to those of controls. Several significant differences were traced between anterior segment values and extramuscular manifestations of myositis, largely in case of arthritis/arthralgia and weight loss, whereas associations between anterior segment parameters and antibodies were weak. Objective clinical tests of DED were also significantly decreased in IIM patients. CONCLUSION: The results suggest that all IIM patients have thinner corneas compared with those of controls, and decreased corneal parameters are significantly associated with the occurrence of some extramuscular manifestations. In addition, IIM patients tend to develop objective signs of DED.

18 Effects of primary glaucoma on sleep quality and daytime sleepiness of patients residing at an equatorial latitude

Jacob YH Chin , Zhi Hong Toh , Ying Tai Lo , Hannah TY Wang , Elizabeth YW Poh , Chun Hau Chua , Owen Kim Hee , Boon Ang Lim , Vernon KY Yong , Augustinus Laude , Hon Tym Wong , Leonard WL Yip

2020, 13(9):1451-1458. DOI: 10.18240/ijo.2020.09.18

[Abstract](1058) [HTML](0) [PDF 393.85 K](604)

Abstract:
AIM: To investigate the impact of primary glaucoma on sleep quality and daytime sleepiness of patients. METHODS: Prospective cross-sectional study with consecutive sampling in South-East Asian population was performed. Validated questionnaires: the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were administered prospectively. Subjects with non-glaucomatous optic neuropathy or concomitant retinal pathology were excluded. Glaucoma severity was based on HVF 24-2 perimetry. Binocular single vision was represented based on the better eye. Frequency of and predictive factors for poor sleep quality and excessive daytime sleepiness were compared. RESULTS: A total of 79 primary open angle glaucoma (POAG), 27 primary angle-closure glaucoma (PACG) patients, and 89 controls were recruited. PACG patients had higher median PSQI scores (P=0.004) and poorer sleep quality (P<0.001). Compared to controls, PACG patients were 3.34 times more likely to have poor sleep quality (P=0.008), which remained significant after adjustment for demographics (P=0.016) and predictive variables (P=0.013). PACG patients have poorer sleep quality when visual acuity (VA) was 6/15 or worse (P=0.009). Univariate and multivariate analysis of predictive variables for poor sleep quality and daytime sleepiness did not find statistical significance. CONCLUSION: PACG patients have poorer sleep quality but not daytime sleepiness. This is important in South-East Asian population with heavy disease burden. Evaluations on sleep disturbances can be considered to provide more holistic care.

19 Topographic distribution features of the choroidal and retinal nerve fiber layer thickness in Chinese 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(9):1459-1466. DOI: 10.18240/ijo.2020.09.19

[Abstract](1481) [HTML](0) [PDF 952.71 K](563)

Abstract:
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 ametropia 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 negatively correlated with AL (y=-21.72x+779.17; R2=0.1458), and positively correlated with SE (y=15.76x+271.9; R2=0.0727, OD; y=18.31x+269.8; R2=0.1007, OS). 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.

20 Influencing factors for peripheral and posterior lesions in mild non-proliferative diabetic retinopathy—the Kailuan Eye Study

Mo-Chi Yang , Xiao-Bo Zhu , Ya-Xing Wang , Shou-Ling Wu , Qian Wang , Yan-Ni Yan , Xuan Yang , Jing-Yan Yang , Meng-Xi Chen , Ya-Hui Lei , Wen-Bin Wei

2020, 13(9):1467-1476. DOI: 10.18240/ijo.2020.09.20

[Abstract](1208) [HTML](0) [PDF 606.50 K](648)

Abstract:
AIM: To explore the influencing factors of diabetes type 2 patients with mild non-proliferative diabetic retinopathy (NPDR) in the Kailuan area of Tangshan, Hebei Province, China. METHODS: In this non-interventional, retrospective study, 683 patients with type 2 diabetes were included in the Kailuan Diabetic Retinopathy Study involving participants with diabetes in the community-based longitudinal Kailuan Study. Based on the undilated ultra-wide field (200°; UWF) images and partial dilated digital fundus images, the diabetic retinopathy (DR) of the surveyed population was graded. Interobserver agreement was estimated by using Cohen’s Kappa statistics. The main outcome indicators included gender, age, weight, height, body mass index, blood pressure, circumferences of neck, waist and hip, current smoking, levels of fasting plasma glucose (FPG), hypersensitive C-reactive protein, creatinine, and cholesterol, etc. According to different lesions’ locations of patients with mild NPDR, logistic regression models were used to estimate the odds ratios (ORs) and their 95%CIs of each risk factor. RESULTS: The study group of 683 patients included 570 males and 113 females. The mean age of the patients was 62.18±9.41y. Compared with dilated fundus examinations, there was fair agreement with the level of DR identified on UWF images in 63.91% of eyes (k=0.369, 95%CI, 0.00-0.00). Detected by UWF images, there were 98 patients with mild NPDR having peripheral retinal lesions, 35 patients with mild NPDR having posterior lesions, 44 patients with mild NPDR whose lesions were detected both in and out the standard two fields area, and 336 patients with non obvious DR. Parameters that conferred a statistically significant increased risks for mild NPDR with having peripheral retinal lesions were neck circumstance (OR, 1.124; 95%CI, 1.044-1.211), and with posterior lesions were FPG (OR, 1.052; 95%CI, 1.007-1.099). CONCLUSION: UWF is an effectiveness means of DR screening. Moreover, it is necessary to evaluate peripheral diabetic retinal lesions which can help to estimate the severity of DR. The phenomenon that nonuniform and inhomogeneous distribution of DR lesions has been found. And the influencing factors in mild NPDR are differing by different lesions’ locations.

21 Increased vitreal levels of interleukin-10 in diabetic retinopathy: a Meta-analysis

Wei Tan , Jing-Ling Zou , Shigeo Yoshida , Bing Jiang , Ye-Di Zhou

2020, 13(9):1477-1483. DOI: 10.18240/ijo.2020.09.21

[Abstract](1139) [HTML](0) [PDF 1.06 M](559)

Abstract:
AIM: To conduct a Meta-analysis for the change of interleukin-10 (IL-10) concentration in vitreous samples of patients with diabetic retinopathy (DR). METHODS: Systemic search for literature was conducted from the databases of PubMed, Web of Science and Cochrane Library by August 2019. Statistical analyses including standard mean difference (SMD) and its 95% confidence interval (CI) were performed by using RevMan 5.3 software. RESULTS: Totally 194 studies were screened and finally 11 studies were included in the Meta-analysis. The concentration of IL-10 in the DR group was higher than in the control group (P=0.003, SMD: 0.77, 95%CI: 0.25-1.28). Significant heterogeneity was found among all studies (P<0.00001, I2=92%). The subgroup analysis showed that the concentration of IL-10 increased in vitreous samples from patients with DR compared to the non-DR controls (P=0.004, SMD: 1.44, 95%CI: 0.46-2.42). Moreover, the concentration of IL-10 in samples of proliferative diabetic retinopathy (PDR) patients was significantly higher than that of non-proliferative diabetic retinopathy (NPDR) patients (P=0.01, SMD: 0.61, 95%CI: 0.13-1.08). CONCLUSION: The vitreal concentration of IL-10 is significantly increased in patients with DR. Further studies are needed to reveal the mechanisms of IL-10 in DR.

22 Characterization of the geometric properties of the sclero-conjunctival structure: a review

Laurent Bataille , David P Pinero

2020, 13(9):1484-1492. DOI: 10.18240/ijo.2020.09.22

[Abstract](1110) [HTML](0) [PDF 867.04 K](612)

Abstract:
To revise the peer-reviewed literature on geometric properties of the scleral-conjunctival structure in order to define their clinical relevance and the potential relationship between their changes and myopia development or progression. A bibliographic search focused on the study of the geometry of conjunctiva and/or sclera as well as those studies evaluating the relationship between geometric changes in the scleral-conjunctival structure and myopia was carried out. Several studies have been performed with different diagnostic technologies, including optical coherence tomography, profilometry and Scheimpflug imaging, to detect geometric changes of the scleral-conjunctival tissue in different physiological conditions of the eye, after use of contact lenses and in different ocular pathologies. Likewise, these technologies have been shown to be a valuable clinical tool to optimize scleral contact lens fitting. Future studies should investigate new potential clinical applications of such technologies, including the evaluation of anterior scleral changes related to myopia, as well as to define standardized clinical standard operating procedures for obtaining accurate and reproducible clinical measurement of the scleral-conjunctival morphology.

23 Progress in exosomes and their potential use in ocular diseases

Su-Fang Li , Ying Han , Feng Wang , Ying Su

2020, 13(9):1493-1498. DOI: 10.18240/ijo.2020.09.23

[Abstract](1833) [HTML](0) [PDF 372.67 K](696)

Abstract:
Exosomes contain a variety of biological active substances such as proteins, miRNAs, lncRNAs and lipids, and exosomes from different cells play different biological functions. Exosomes, as a carrier, are involved in many pathological processes such as nerve injury and repair, vascular regeneration, immune response, and fibrosis formation. It plays an important role in the treatment of eye diseases such as glaucoma, diabetic retinopathy, and keratitis. This paper reviews the research progress of exosomes in various diseases in vivo, which provides a new way for the treatment of eye diseases.

24 Intraocular lens implantation and vitrectomy using 0.025% povidone-iodine in irrigation solution for bleb-related endophthalmitis

Yorihisa Kitagawa , Hiroyuki Shimada , Hiroyuki Nakashizuka , Takayuki Hattori , Yoshio Yamazaki

2020, 13(9):1499-1502. DOI: 10.18240/ijo.2020.09.24

[Abstract](795) [HTML](0) [PDF 946.76 K](539)

Abstract:

25 Managements of vertical gas breakthrough in femtosecond laser assisted LASIK

Cheng-Hua Wei , Li-Xin Mei , Yao Ge , Peng-Fei Zhang

2020, 13(9):1503-1504. DOI: 10.18240/ijo.2020.09.25

[Abstract](1581) [HTML](0) [PDF 565.86 K](483)

Abstract:

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Volume 13,Issue 9,2020 Table of Contents