Volume 14,Issue 1,2021 Table of Contents

1 Response of L V Prasad Eye Institute to COVID-19 outbreak in India: experience at its tertiary eye care centre and adoption to its Eye Health Pyramid

Rohit C Khanna , Prashant Garg , Pravin K Vaddavalli , Merle Fernandes , Suryasnata Rath , Sameera Nayak , Raja Narayanan , Rajeev Reddy Pappuru , Swathi Kaliki , Anthony Vipin Das , Savitri Sharma , Subhadra Jalali

2021, 14(1):1-9. DOI: 10.18240/ijo.2021.01.01

[Abstract](1638) [HTML](0) [PDF 519.96 K](804)

Abstract:
AIM: To summarize the experience of response to COVID-19 outbreak at a tertiary eye care institute and its network of health facilities in India. METHODS: Our responses are based on the principles of social distancing, hand hygiene, respiratory etiquettes, surface disinfection protocol, and rational use of appropriate personal protective equipment (PPE). We describe our response in terms of administrative controls, clinical protocols, staff protection, environmental controls, and social distancing measures. We also discuss our communication strategies and monitoring systems, to ensure compliance to protocols. RESULTS: Administrative control is mainly related to formation of task force and its functions. Clinical protocols are related to patient triaging methods and clinical examination guidelines in Outpatient, Inpatient and Operating Room. Staff protection is focused on training staff on the protocols to be followed in hospital as well as at home, and use of PPE. Environmental protocol is focused on cleaning and disinfectant methods to be used in the hospital. In addition, there are systems for communication as well as monitoring compliance to protocols. CONCLUSION: We hope that these protocols and our experience would help the ophthalmic community globally and serve as a guide to protect ophthalmologists and ophthalmic care personnel, and their patients across the world.

2 Preliminary studies of constructing a tissue-engineered lamellar corneal graft by culturing mesenchymal stem cells onto decellularized corneal matrix

Yu-Jie Cen , De-Bo You , Wei Wang , Yun Feng

2021, 14(1):10-18. DOI: 10.18240/ijo.2021.01.02

[Abstract](1317) [HTML](0) [PDF 2.15 M](767)

Abstract:
AIM: To construct a competent corneal lamellar substitute in order to alleviate the shortage of human corneal donor. METHODS: Rabbit mesenchymal stem cells (MSCs) were isolated from bone marrow and identified by flow cytometric, osteogenic and adipogenic induction. Xenogenic decellularized corneal matrix (XDCM) was generated from dog corneas. MSCs were seeded and cultured on XDCM to construct the tissue-engineered cornea. Post-transplantation biocompatibility of engineered corneal graft were tested by animal experiment. Rabbits were divided into two groups then underwent lamellar keratoplasty (LK) with different corneal grafts: 1) XDCM group (n=5): XDCM; 2) XDCM-MSCs groups (n=4): tissue-engineered cornea made up with XDCM and MSCs. The ocular surface recovery procedure was observed while corneal transparency, neovascularization and epithelium defection were measured and compared. In vivo on focal exam was performed 3mo postoperatively. RESULTS: Rabbit MSCs were isolated and identified. Flow cytometry demonstrated isolated cells were CD90 positive and CD34, CD45 negative. Osteogenic and adipogenic induction verified their multipotent abilities. MSC-XDCM grafts were constructed and observed. In vivo transplantation showed the neovascularization in XDCM-MSC group was much less than that in XDCM group postoperatively. Post-transplant 3-month confocal test showed less nerve regeneration and bigger cell-absent area in XDCM-MSC group. CONCLUSION: This study present a novel corneal tissue-engineered graft that could reduce post-operatively neovascularization and remain transparency, meanwhile shows that co-transplantation of MSCs may help increase corneal transplantation successful rate and enlarge the source range of corneal substitute to overcome cornea donor shortage.

3 Therapeutic potential of Rho-associated kinase inhibitor Y27632 in corneal endothelial dysfunction: an in vitro and in vivo study

Yao-Wen Song , Jun-Yu Chen , Xu Li , Li Wang , Zhi-Qiang Pan

2021, 14(1):19-25. DOI: 10.18240/ijo.2021.01.03

[Abstract](1310) [HTML](0) [PDF 1.61 M](802)

Abstract:
AIM: To investigate the effects of a selective inhibitor of Rho-associated kinase (ROCK), Y-27632, on inbred Wuzhishan porcine corneal endothelial cells (PCECs) in vitro and in vivo studies. METHODS: Primary PCECs were trypsinized from Wuzhishan miniature porcine corneal tissues. The optimal concentration of Y-27632 on PCECs was determined through MTT and 5-ethynyl-2’-deoxyuridine (EdU)-labeling assays. Seven New Zealand rabbits were used as a corneal endothelial dysfunction model, and a PCECs suspension supplemented with Y-27632 was injected into the anterior chamber of the rabbits. The progression of rabbit corneal opacity and edema were observed by slit lamp examination. The rabbits were sacrificed, and rabbit globes were enucleated for trypan blue-alizarin red staining, hematoxylin-eosin staining, and immunofluorescence analysis. RESULTS: Administration of 100 μmol/L Y-27632 facilitated PCECs’ proliferation obviously. The rabbit corneas injected with PCECs suspension and 100 μmol/L Y-27632 were restored to transparency significantly after 14d. CONCLUSION: The 100 μmol/L Y-27632 treatment improves PCECs’ proliferation significantly. And our results suggest that Y-27632 and PCECs can be used to treat corneal endothelial dysfunction.

4 Changes of matrix metalloproteinases in the stroma after corneal cross-linking in rabbits

Hong-Zhen Jia , Xu Pang , Xiu-Jun Peng

2021, 14(1):26-31. DOI: 10.18240/ijo.2021.01.04

[Abstract](1047) [HTML](0) [PDF 614.22 K](658)

Abstract:
AIM: To observe changes in the content of matrix metalloproteinases (MMPs) in the corneal stroma after corneal cross-linking (CXL) in rabbits, and further explore the corneal pathophysiological process after CXL. METHODS: Forty-two rabbits (42 eyes) were randomly divided into seven groups. One group served as the control group, while the other six groups were treated with CXL. The concentrations of MMPs in corneal stroma were evaluated through parallel reaction monitoring at baseline and 3, 7, 15, 30, 90, and 180d after treatment. RESULTS: The levels of MMP-2 in the corneal stroma of rabbits were 0.76±0.07, 2.78±1.39, 4.12±0.69, 2.00±0.29, 2.00±0.30, 1.22±0.18, and 1.35±0.18 (10-9 mol/g) at baseline and 3, 7, 15, 30, 90, and 180d after treatment, respectively. The contents of tissue inhibitor of metalloproteinase-1 (TIMP-1) were 1.83±0.26, 7.94±0.58, 6.95±2.64, 3.81±0.48, 3.07±0.92, 1.72±0.19, and 1.69±0.74 (10-9 mol/g), respectively. The ratios of MMP-2/TIMP-1 were 0.42±0.33, 0.36±0.20, 0.62±0.10, 0.54±0.15, 0.68±0.13, 0.71±0.10, and 0.68±0.09, respectively. After CXL, the expression of MMP-2 and TIMP-1 in the rabbit corneal stroma was initially increased and subsequently decreased. The levels of MMP-2 remained higher than those recorded at baseline 180d after treatment, but it was not statistically significant. The levels of TIMP-1 returned to baseline levels at 90d after treatment. The ratio of MMP-2/TIMP-1 started to rise from 7d after CXL. It was significantly higher than that calculated at baseline 30-180d after CXL. The results for MMP-1, -3, -7, -9, -13, and TIMP-2 were negative. CONCLUSION: CXL can lead to changes in the content of MMP-2 and TIMP-1 in the rabbit corneal stroma. The ratio of MMP-2/TIMP-1 remains higher versus baseline, indicating that MMP-2 is involved in the corneal pathophysiological process after CXL.

5 A multi-omics study on cutaneous and uveal melanoma

Qi Zhang , Ze-Nan Lin , Jie Chen , Wen-Xu Zheng

2021, 14(1):32-41. DOI: 10.18240/ijo.2021.01.05

[Abstract](1394) [HTML](0) [PDF 2.58 M](902)

Abstract:
AIM: To present the multi-omics landscape of cutaneous melanoma (CM) and uveal melanoma (UM) from The Cancer Genome Atlas (TCGA). METHODS: The differentially expressed genes (DEGs) between CM and UM were found and integrated into a gene ontology enrichment analysis. Besides, the differentially expressed miRNAs were also identified. We also compared the methylation level of CM with UM and identified the differentially methylated regions to integrate with the DEGs to display the relationship between the gene expression and DNA methylation. The differentially expressed transcription factors (TFs) were identified. RESULTS: Though CM had more mutational burden than UM, they shared several similarities such as the same rankings in diverse variant types. Except GNAQ and GNA11, the other top 18 mutated genes of the combined group were mostly detected in CM instead of UM. On the transcriptomic level, 4610 DEGs were found and integrated into a gene ontology enrichment analysis. We also identified 485 differentially expressed miRNAs. The methylation analysis showed that UM had a significantly higher methylation level than CM. The integration of differentially methylated regions and DEGs demonstrated that most DEGs were downregulated in UM and the hypo- and hypermethylation presented no obvious difference within these DEGs. Finally, 116 hypermethylated TFs and 114 hypomethylated TFs were identified as differentially expressed TFs in CM when compared with UM. CONCLUSION: This multi-omics study on comparing CM with UM confirms that they differ in all analyzed levels. Of notice, the results also offer new insights with implications for elucidating certain unclear problems such as the distinct role of epithelial mesenchymal transition in two melanomas, the different metastatic routes of CM and UM and the liver tropism of metastatic UM.

6 Effects of quercetin on diabetic retinopathy and its association with NLRP3 inflammasome and autophagy

Rong Li , Lin Chen , Guo-Min Yao , Hong-Lin Yan , Li Wang

2021, 14(1):42-49. DOI: 10.18240/ijo.2021.01.06

[Abstract](2048) [HTML](0) [PDF 2.48 M](1070)

Abstract:
AIM: To investigate the effects of quercetin on diabetic retinopathy (DR) and its association with nucleotide-binding oligomerization domain-like receptors 3 (NLRP3) inflammasome and autophagy using retinal endothelial cell as an experimental model. METHODS: Human retinal microvascular endothelial cells (HRMECs) were cultured in vitro and assigned into the control group, high-glucose (HG) group, and HG+different concentrations of quercetin groups. Cellular viability, migration, and tube formation in these groups was detected by MTT, transwell and matrigel assay, respectively. Expressions of NLRP3, apoptosis-associated speck-like protein (ASC), cysteiny aspartate-specific protease-1 (Caspase-1) as well as microtubule-related protein 1 light chain 3 (LC3) and Beclin-1 were detected by Western blotting. Expressions of IL-1β and IL-18 were detected by ELISA and cellular autophagy was detected by Cyto-ID® autophagy detection kit. RESULTS: Under an HG condition, the viability, migration, tube formation of HRMECs, and the protein expressions of NLRP3, ASC, Caspase-1, IL-1β, IL-18, LC3, and Beclin-1 as well as autophagy were all increased. Quercetin inhibited angiogenesis of HRMECs as well as the expressions of NLRP3, ASC, Caspase-1, IL-1β, IL-18, LC3, Beclin-1, and autophagy of HRMECs under a HG condition. The inhibitory effects of quercetin on angiogenesis, NLRP3 inflammasome and autophagy increased with the increase of its concentration. CONCLUSION: The therapeutic potential of quercetin in retinal neovascularization of DR, and inhibition of NLRP3 inflammasome and autophagy signaling pathway may be involved.

7 RNA interference targeting NOX4 protects visual function in an experimental model of retinal detachment by alleviating blood-retinal barrier damage

Kai Dong , Nan Yang , Jie Ding , Yuan-Ye Yan , Li Lu , Yi-Sai Wang

2021, 14(1):50-56. DOI: 10.18240/ijo.2021.01.07

[Abstract](1221) [HTML](0) [PDF 1.17 M](817)

Abstract:
AIM: To observe the effects of the inhibition of NADPH oxidase 4 (NOX4) expression on the retinal vascular barriers and visual function after retinal detachment (RD). METHODS: RD model was established 3wk after adeno-associaned virus vector injection. The retinal tissue was harvested 3d after RD, and the death of retinal vascular endothelial cells and photoreceptors was observed using electron microscopy. The NOX4 expression was detected by Western blot. Confocal microscopy was used to observe a retinal patch that had been perfused with Evans blue. A modified water maze test was used to detect the time required to find the platform on the water surface. The visual function of the rats was evaluated and reactive oxygen species (ROS) expression was detected by a fluorescence microplate reader. RESULTS: The retinal patch showed that NOX4 interference significantly reduced the destruction of the tight junctions between the retinal endothelium of RD rats and reduced leakage. Western blotting showed decreased expression of the NOX4 protein and decreased expression of ROS in retinal tissue; the Morris water maze test results showed that NOX4 interference significantly decreased the escape latency of the rats. CONCLUSION: NOX4 interference reduces the production of ROS in retinal vascular endothelial cells after experimental RD, thereby protecting the blood-retinal barrier and protecting visual function.

8 Exploratory study of non-invasive, high-resolution functional macular imaging in subjects with diabetic retinopathy

Thalmon R. Campagnoli , Gábor Márk Somfai , Jing Tian , Delia Cabrera DeBuc , William E. Smiddy

2021, 14(1):57-63. DOI: 10.18240/ijo.2021.01.08

[Abstract](858) [HTML](0) [PDF 1.00 M](728)

Abstract:
AIM: To evaluate a high-resolution functional imaging device that yields quantitative data regarding macular blood flow and capillary network features in eyes with diabetic retinopathy (DR). METHODS: Prospective, cross-sectional comparative case-series in which blood flow velocities (BFVs) and non-invasive capillary perfusion maps (nCPMs) in macular vessels were measured in patients with DR and in healthy controls using the Retinal Functional Imager (RFI) device. RESULTS: A total of 27 eyes of 21 subjects were studied [9 eyes nonproliferative diabetic retinopathy (NPDR), 9 eyes proliferative diabetic retinopathy (PDR) and 9 controls]. All diabetic patients were type 2. All patients with NPDR and 5 eyes with PDR also had diabetic macular edema (DME). The NPDR group included eyes with severe (n=3) and moderate NPDR (n=6), and were symptomatic. A significant decrease in venular BFVs was observed in the macular region of PDR eyes when compared to controls (2.61±0.6 mm/s and 2.92±0.72 mm/s in PDR and controls, respectively, P=0.019) as well as PDR eyes with DME compared to NPDR eyes (2.36±0.51 mm/s and 2.94±1.09 mm/s in PDR with DME and NPDR, respectively, P=0.01). CONCLUSION: The RFI, a non-invasive imaging tool, provides high-resolution functional imaging of the retinal microvasculature and quantitative measurement of BFVs in visually impaired DR patients. The isolated diminish venular BFVs in PDR eyes compared to healthy eyes and PDR eyes with DME in comparison to NPDR eyes may indicate the possibility of more retinal vein compromise than suspected in advanced DR.

9 Visual outcomes of surgical and conservative treatment in children with small posterior polar cataracts and posterior lenticonus

Hui Chen , Wan Chen , Xiang-Hua Wu , Zhuo-Ling Lin , Jing-Jing Chen , Xiao-Yan Li , Wei-Rong Chen , Hao-Tian Lin

2021, 14(1):64-71. DOI: 10.18240/ijo.2021.01.09

[Abstract](1091) [HTML](0) [PDF 658.75 K](682)

Abstract:
AIM: To compare the visual outcomes of children with small (≤3 mm) posterior polar cataracts (PPC) and posterior lenticonus who had cataract extraction surgery with the visual outcomes of those who were managed conservatively. METHODS: Children who initially had small PPC and posterior lenticonus who were followed up over 1-year period were retrospective reviewed in the study. Patients receiving surgery were compared with those receiving conservative therapy. The axial length, keratometry, refraction, best-corrected visual acuity (BCVA), and strabismus measurements were recorded. Lens morphology, i.e., the location, size, and depth of the cataract lesion, was measured with a Scheimpflug imaging system. To help control for baseline differences in the groups, patients were matched with controls by propensity score methodology. RESULTS: The study evaluated 60 patients (30 in the surgery group and 30 in the conservative therapy group) after matching by propensity score. Patients who underwent cataract surgery showed greater BCVA improvements (0.36±0.24 logMAR) than patients who were treated without surgery (0.22±0.26 logMAR; P=0.036). Surgery was effective in patients with a rear projection length (RPL) less than 1.0 mm and a pretreatment BCVA worse than 0.52 logMAR. CONCLUSION: Children with small PPC and posterior lenticonus who undergo cataract surgery experience greater BCVA improvements than those managed conservatively. Certain patients presenting with a RPL less than 1.0 mm and a pretreatment BCVA of 0.52 logMAR or worse may benefit from surgery.

10 Long-term follow-up of cataract surgery in eyes filled with silicone oil

Piotr Kanclerz , Christoph Leisser , Andrzej Grzybowski , Pawel Lipowski

2021, 14(1):72-75. DOI: 10.18240/ijo.2021.01.10

[Abstract](945) [HTML](0) [PDF 346.04 K](707)

Abstract:
AIM: To evaluate the refractive and long-term outcome of eyes filled with silicone oil (SO) undergoing phacoemulsification cataract surgery (PCS). METHODS: This retrospective study evaluated patients with SO tamponade who were scheduled for PCS. RESULTS: Subjects (n=26) were followed for 29.5±13.9mo after cataract surgery. The median spherical equivalent refraction (SER) was +5.3 D [interquartile range (IQR) +2.9 to +6.7] before PCS, and +3.4 D (IQR +2.0 to +4.4) after PCS. Within the follow-up period retinal reattachment after SO removal was achieved in 15 out of 26 eyes (57.7%). In 13 eyes assessment of refraction after SO-removal was possible, and showed a myopic shift of -4.6 D (IQR -2.9 to -7.3) in the SER. After SO removal, 5 of the 13 eyes (38.5%) were within ±1.0 D of the target refraction, while 9 out of the 13 eyes (69.2%) were within ±2.0 D. CONCLUSION: In our study, the refraction after PCS for eyes filled with SO manifested low predictability, as did the myopic shift following SO removal. A significant percentage of the eyes that underwent SO administration required a long-term tamponade.

11 Early results of circularity and centration of capsulotomy prepared by three different methods

Jagadesh C. Reddy , Soumya Devta , Kiran Kumar Vupparaboina , Mohammad Hasnat Ali , Pravin K. Vaddavalli

2021, 14(1):76-82. DOI: 10.18240/ijo.2021.01.11

[Abstract](809) [HTML](0) [PDF 981.75 K](616)

Abstract:
AIM: To compare the difference of capsulotomy produced by precision pulse capsulotomy (PPC), manual (M-CCC), and femtosecond laser assisted capsulotomy (FLAC) in relation to intraocular lens (IOL) centration, circularity and its effect on visual outcomes. METHODS: Prospective, non-randomized comparative study conducted at LV Prasad Eye Institute, Hyderabad, India. Sixty eyes of 52 patients were grouped into 3 (FLAC, PPC and M-CCC) based on capsulotomy techniques used. Twenty consecutive eyes with uneventful phacoemulsification and with no comorbidities affecting the capsulotomy or visual outcome were included in each group. The main outcome measure was IOL centration in relation to capsulotomy and pupil. Secondary outcome measures were post-operative visual acuity, manifest refraction and aberration profile between groups. RESULTS: At 5wk the visual, refractive outcomes and endothelial cell density were comparable between the 3 groups. The median circularity index of FLAC was statistically significantly different to M-CCC or PPC (1-10) groups (P<0.01) but PPC (11-20) was comparable to FLAC. Decentration of IOL center in relation to capsulotomy was seen only between the PPC (1-10) group and FLAC group (P=0.02). The IOL was well centered in relation to the pupil in all the groups (P=0.46). The quality of vision parameters like the higher order aberrations, spherical aberration, coma, trefoil, modular transfer function, and Strehl ratio were comparable between the groups. CONCLUSION: Our study shows that despite differences in the morphology of capsulotomy produced by PPC, M-CCC, FLAC a well-centered IOL can be achieved. The measured capsular morphology parameters do not affect visual outcomes.

12 Leptin’s concentration in tears and dry eye: a clinical observational study

Ran Hao , Yan Liu , Xue-Min Li

2021, 14(1):83-88. DOI: 10.18240/ijo.2021.01.12

[Abstract](1506) [HTML](0) [PDF 1.05 M](762)

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AIM: To investigate the concentration of leptin in tears and its correlation with dry eye symptoms and signs. METHODS: The study enrolled individuals (n=39) responding to an advertising or dry eye patients (n=58) from the Ophthalmology Department. Tear samples were collected for leptin concentration measuring. Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), tear break up time (TBUT), cornea fluorescein staining, Schirmer test (ST) and impression cytology (IC) were assessed. Leptin concentration in tears of dry eye patients and healthy controls, and its correlation with clinical features of dry eye disease (DED) were analyzed. RESULTS: Age, body mass index (BMI), OSDI scores and cornea fluorescein staining scores showed a negative correlation with leptin concentration in tears (r=-0.340, P=0.001; r=-0.332, P=0.001; r=-0.258, P=0.011; r=-0.424, P<0.001, respectively). ST showed positive correlation with leptin concentration in tears (r=0.206, P=0.045). No significant difference was observed in leptin concentration between dry eye patients and controls (P=0.682). Multivariate linear regression analysis revealed that dry eye, OSDI, corneal fluorescein staining scores and ST correlated with leptin concentration in tears. CONCLUSION: This is the first study measuring leptin concentration in tears. The correlation between leptin concentration and DED symptoms and signs reveal that leptin level correlated with the dry eye, potentially contributing to repair of ocular damage and dry eye improvement.

13 Corneal epithelial thickness analysis of forme fruste keratoconus with optical coherence tomography

Xiao-Long Yang , Yun Wang , Bao-Gen Luo , Yue Xu , Xiao-Feng Zhang

2021, 14(1):89-96. DOI: 10.18240/ijo.2021.01.13

[Abstract](1346) [HTML](0) [PDF 1.28 M](809)

Abstract:
AIM: To explore the significance of corneal epithelial thickness analysis in diagnosing early keratoconus. METHODS: There were 26 clinical keratoconus, 21 forme fruste keratoconus, 40 high corneal astigmatism (ΔK) and 40 low ΔK eyes involved in the study. Fourier-domain optical coherence tomography was used to measure the corneal epithelial thickness of four groups. The morphological features of topographic map and the thickness of corneal epithelial thinnest point were analyzed. The distribution curve of corneal epithelial thickness at 45°, 90°, and 135° axial directions that are through the pupil center was also analyzed. One-way ANOVA was performed to compare the data. RESULTS: The topographic map of forme fruste keratoconus corneal epithelial thickness was uniformity shape; crater shape existed only in clinical keratoconus group; and central island shape mainly existed in high ΔK group. The thinnest point of corneal epithelial thickness of forme fruste keratoconus group was significantly lower than that of low ΔK group (P=0.022). The thickness of corneal epithelium in the forme fruste keratoconus at 90° was thinner than that in the low astigmatism group at -1, and -2 mm points (P-1 mm=0.015, P-2 mm=0.036). CONCLUSION: The analysis of the thinnest point in forme fruste keratoconus corneal epithelium appears earlier than corneal epithelial remodeling. The topographic map of corneal epithelium in high ΔK eyes appears in central island shape, and can be used for the differential diagnosis of early keratoconus.

14 Endogenous fungal endophthalmitis: risk factors, clinical course, and visual outcome in 13 patients

Jamel Corredores , Itzhak Hemo , Tareq Jaouni , Zohar Habot-Wilner , Michal Kramer , Shiri Shulman , Haneen Jabaly-Habib , Ala'a Al-Talbishi , Michael Halpert , Edward Averbukh , Jaime Levy , Iris Deitch-Harel , Radgonde Amer

2021, 14(1):97-105. DOI: 10.18240/ijo.2021.01.14

[Abstract](1097) [HTML](0) [PDF 1015.29 K](876)

Abstract:
AIM: To analyze the risk factors, ophthalmological features, treatment modalities and their effect on the visual outcome in patients with endogenous fungal endophthalmitis (EFE). METHODS: Data retrieved from the medical files included age at presentation to the uveitis clinic, gender, ocular symptoms and their duration before presentation, history of fever, eye affected, anatomical diagnosis and laboratory evidence of fungal infection. Medical therapy recorded included systemic antifungal therapy and its duration, use of intravitreal antifungal agents and use of oral/intravitreal steroids. Surgical procedures and the data of ophthalmologic examination at presentation and at last follow-up were also collected. RESULTS: Included were 13 patients (20 eyes, mean age 58y). Ten patients presented after gastrointestinal or urological interventions and two presented after organ transplantation. In one patient, there was no history of previous intervention. Diagnostic vitrectomy was performed in 16 eyes (80%) and vitreous cultures were positive in 10 of the vitrectomized eyes (62.5%). In only 4 patients (31%), blood cultures were positive. All patients received systemic antifungal therapy. Sixteen eyes (80%) received intravitreal antifungal agent with voriconazole being the most commonly used. Visual acuity (VA) improved from 0.9±0.9 at initial exam to 0.5±0.8 logMAR at last follow-up (P=0.03). A trend of greater visual improvement was noted in favor of eyes treated with oral steroids (±intravitreal dexamethasone) than eyes that were not treated with steroids. The most common complication was maculopathy. Twelve eyes (60%) showed no ocular complications. CONCLUSION: High index of suspicion in patients with inciting risk factors is essential because of the low yield of blood cultures and the good general condition of patients at presentation. Visual prognosis is improved with the prompt institution of systemic and intravitreal pharmacotherapy and the immediate surgical intervention. Oral±local steroids could be considered in cases of prolonged or marked inflammatory responses in order to hasten control of inflammation and limit ocular complications.

15 Risk factors for persistent epiphora following successful canalicular laceration repair

Ying-Yan Qin , Zuo-Hong Li , Feng-Bin Lin , Yu Jia , Jun Mao , Cong-Yao Wang , Xuan-Wei Liang

2021, 14(1):106-111. DOI: 10.18240/ijo.2021.01.15

[Abstract](960) [HTML](0) [PDF 1.08 M](698)

Abstract:
AIM: To identify the risk factors of epiphora in patients with anatomical patency after surgical repair of canalicular laceration. METHODS: This retrospective case series included 178 cases of canalicular laceration repair from 2005 to 2012. Demographic data collected from each patient included age, sex, type of injury, distance from the distal lacerated end of the canaliculus to the punctum, the severity score for the structural abnormity of the medial canthus, the duration of stent placement, and the timing of surgery. The risk factors for epiphora were evaluated using Logistic regression models. RESULTS: Among the 178 cases, 45 (25.3%) with lacrimal patency after irrigation had symptomatic epiphora at the final follow-up. Patients’ sex, age, type of injury, duration of stent placement, timing of surgery, and concurrent trauma were not found to be signi?cantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus (P>0.05). A distance of more than 5 mm from the distal cut end to the punctum was closely and significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus (P<0.01). Symptomatic epiphora was significantly more frequent in patients with higher severity scores for structural abnormities of the medial canthus (P<0.01). CONCLUSION: Our results indicate that the risk factors for postoperative symptomatic epiphora include a further distance between the distal cut end and the lacrimal punctum and a higher severity score for structural abnormities of the medial canthus. These findings could be used to prognosticate postoperative symptomatic epiphora.

16 Impact of binocular visual field loss on driving performance in glaucoma patients

Zhen-Ying Jiang , Jing Chen , Jing Yao , Shao-Hong Qian

2021, 14(1):112-119. DOI: 10.18240/ijo.2021.01.16

[Abstract](1087) [HTML](0) [PDF 1.04 M](706)

Abstract:
AIM: To evaluate the driving performance in young and middle-aged Chinese glaucoma patients with mild to severe visual field loss compared to those without glaucoma by using a driving simulation test. METHODS: Twenty-nine participants were included in this study: nine patients with glaucoma but pass the binocular Esterman visual field test, ten patients with glaucoma and fail the binocular Esterman visual field test, and ten age-matched healthy controls. A driving simulation test was designed as a frequency-based analysis of a lane-keeping task. The total performance error, the control-response amplitude and delay were calculated. RESULTS: Esterman visual field test fail group showed the longest delay of control-response among three groups (P=0.02). And the delay in lane-keeping task was significantly associated with inferior field of better-eye (r=0.51, P=0.004) and integrated visual field (r=0.55, P=0.002). CONCLUSION: Young and middle-aged glaucoma patients with binocular visual field loss suffered from a longer delay of response in driving simulation test, while inferior visual field having more impact than superior visual field.

17 Vitreoretinal surgeons’ experience and time interval from pars-plana vitrectomy to cataract extraction

Yan-Xin Xu , Liang-Ping Liu , Jian-Bing Li , Huan-Huan Cheng , Min Hou , Lin Lu , Ming-Xing Wu

2021, 14(1):120-126. DOI: 10.18240/ijo.2021.01.17

[Abstract](874) [HTML](0) [PDF 743.56 K](688)

Abstract:
AIM: To identify the association of the vitreoretinal surgeons’ experience with the time interval between pars-plana vitrectomy (PPV) and cataract extraction (CE). METHODS: Eyes with prior PPV and following CE were included in this retrospective cohort study. The years of practice and the annual case volume were used to describe the surgeons’ experience. Multivariable linear regression analysis was used to investigate the relationship between surgeons’ experience and the time interval adjusted for the patients age, gender, intraocular tamponade, and case complexity. RESULTS: Of 132 430 eyes, 1445 eyes were included in this study. In multivariable linear regression analysis, cases performed by surgeons with >20 practice years had longer time intervals compared with surgeons with <10 practice years after adjusted for other variables (β=0.329, 95%CI: 0.113 to 0.549, P=0.003). No difference in time interval was detected for comparing the lowest with the highest volume groups (β=0.089, 95%CI: -0.164 to 0.343, P=0.343). The surgeons’ practice years were not directly with the volume. For complicated surgery, the higher-practice-year surgeons had longer time interval than lower-practice-year surgeons. CONCLUSION: The time intervals from PPV to CE is longer in higher-practice-year surgeons. The surgeons’ practice years may have a greater effect on the time interval than annual case volume in high-complexity cases. Matching the complexity of vitreoretinal diseases with the surgeons’ practice year should be considered.

18 Efficacy of the WINROP algorithm for retinopathy of prematurity screening in Southern China

Yi-Chen Bai , Rong Wu , Si-Zhe Chen , Shi-Yu Wei , Hui-Jie Chen , Yan-Chen Chen , Song-Fu Feng , Xiao-He Lu

2021, 14(1):127-132. DOI: 10.18240/ijo.2021.01.18

[Abstract](1004) [HTML](0) [PDF 384.87 K](573)

Abstract:
AIM: To evaluate the predicting efficacy of severe retinopathy of prematurity (ROP) by the WINROP algorithm (http://winrop.com) in Southern China. METHODS: All preterm infants with the gestational age (GA) less than 32wk were included. Their ROP screening results and serial postnatal body weight were analysed retrospectively. Weekly body weight was entered into and measured by the WINROP system. The outcomes were analysed, and the sensitivity, specificity, positive predictive value and negative predictive value (NPV) were calculated. RESULTS: Totally 432 infants with a median GA of 30.0 (24.0-31.9)wk, and a median birth weight (BW) of 1360 (540-2700) g were included. Among these 432 infants, 50 were diagnosed as type 1 ROP but only 28 were identified by the WINROP algorithm. The sensitivity was 56% (28/50) and the NPV was 92% (252/274). However, for infants with BW <1000 g or GA <28wk, the sensitivity was 93.8% (15/16) and 93.3% (14/15), respectively. Meanwhile, with several postnatal complications added as additional risk factors, the sensitivity was increased to 96% (48/50). CONCLUSION: The sensitivity of the WINROP algorithm from the Southern Chinese cohort is not as high as that reported in developed countries. This algorithm is effective for detecting severe ROP from extremely small or preterm infants. Modification of the algorithm with additional risk factors could improve the predictive value for infants with a GA>28wk in China.

19 Epidemiology and risk factors for sports- and recreation-related eye injury: a multicenter prospective observational study

Dong Eun Lee , Hyun Wook Ryoo , Sungbae Moon , Jae Yun Ahn , Jung Ho Kim , Jong-Yeon Kim

2021, 14(1):133-140. DOI: 10.18240/ijo.2021.01.19

[Abstract](1057) [HTML](0) [PDF 510.88 K](723)

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AIM: To identify the epidemiologic characteristics of sports- and recreation-related eye injuries in a large metropolitan city and investigate risk factors associated with visual impairment. METHODS: We performed a multicenter prospective observational study on patients using the regional eye injury registry data. This study included patients with sports- and recreation-related eye injury in four tertiary teaching hospitals in Daegu, Republic of Korea, from August 2016 to July 2018. The primary outcome was visual impairment at the first hospital visit. Distributions of sex, age, place, and causative materials were analyzed according to causative activities. To examine the association between causative activities and visual impairment, a Logistic regression analysis was used. RESULTS: Of the 349 sports- and recreation-related eye injuries, soccer was the most common causative activity, with 21.8% (n=76). Sports- and recreation-related eye injuries occurred mainly in teenagers, individuals in their 20s, and men. Badminton and soccer were significantly associated with visual impairment at the first hospital visit compared with combat sports [(adjusted odds ratio (AOR), 5.18; 95% confidence interval (CI), 1.67-16.09 for badminton and AOR, 3.87; 95%CI, 1.36-10.99 for soccer]. CONCLUSION: Intervention efforts such as deployment of protective eyewear in sports facilities and schools and promotion of wearing protective eyewear during these activities in teenagers and individuals in their 20s are mandatory.

20 Association between retinopathy, nephropathy, and periodontitis in type 2 diabetic patients: a Meta-analysis

Hui-Qun Wu , Xiao Wei , Jin-Yi Yao , Jian-Yan Qi , Hui-Min Xie , Ai-Min Sang , Kui Jiang

2021, 14(1):141-147. DOI: 10.18240/ijo.2021.01.20

[Abstract](1348) [HTML](0) [PDF 1.22 M](736)

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AIM: To verify the association between retinopathy, nephropathy, and periodontitis in type 2 diabetic (T2D) patients. METHODS: Several electronic databases were available for our comprehensive search including China National Knowledge Infrastructure (CNKI), Chinese VIP Information (VIP), Wanfang, Web of Science, ScienceDirect and PubMed and were queried for relevant citations (updated to Mar. 2019). RevMan was utilized to perform Meta analysis and publication bias detection. After evaluation of the methodological quality of included studies, a fixed or random effect model was utilized to analyze data from included studies. RESULTS: A total of eight articles were finally included in this Meta analysis. In all 3987 subjects, there were 1207 T2D patients accompanying with microvascular complications and 1734 patients with periodontitis as well. The Meta forest plot presented little heterogeneity of the eight studies (P<0.00001, I2=89%). The total effect demonstrated periodontitis was associated with overall microvascular complications (OR: 1.96, 95%CI: 1.67-2.30, Z=8.25, P<0.00001). Subgroup investigations among the studies in Asian (OR: 2.33, 95%CI: 1.91-2.85) and North American (OR: 1.42, 95%CI: 1.08-1.86) populations confirmed the existed association between retinopathy, nephropathy, and periodontitis. While the strength of such associations between periodontitis and diabetic microvascular complications were more obvious in the Asians than North Americans. All the results indicated that periodontitis was associated with diabetic retinopathy (OR: 3.77, 95%CI: 2.71-5.24), diabetic nephropathy (OR: 1.55, 95%CI: 1.24-1.94) in T2D patients. CONCLUSION: The periodontitis is associated with diabetic retinopathy, diabetic nephropathy among T2D patients and further large sample size clinical trials are in need to confirm the findings.

21 Sustained-release drug delivery systems for the treatment of glaucoma

Natasha P. Kesav , Cara E. Capitena Young , Monica K. Ertel , Leonard K. Seibold , Malik Y. Kahook

2021, 14(1):148-159. DOI: 10.18240/ijo.2021.01.21

[Abstract](2301) [HTML](0) [PDF 382.33 K](1024)

Abstract:
Glaucoma, a leading cause of irreversible blindness, affects more than 64 million people worldwide and is expected to grow in number due to the aging global population and enhanced methods of detection. Although topical therapies are often effective when used as prescribed, the drawbacks of current medical management methods include poor patient adherence, local and systemic side effects, and in some cases, limited therapeutic efficacy. Novel ocular drug delivery platforms promise to deliver differentiated drug formulations with targeted delivery leveraging patient-independent administration. Several platforms are in various stages of development with promising pre-clinical and clinical data. The Bimatoprost Sustained Release (SR) intracameral implant was approved in the United States in March of 2020, making it the first long-term injectable therapy available for the treatment of glaucoma. This review aims to provide an update on novel sustained release drug delivery systems that are available today as well as those that might be commercialized in coming years.

22 A direct observation of aqueous humour flow in vivo after implantable collamer lens with a central hole implantation

Mei-Yan Li , Feng Zhao , Pei-Jun Yao , Ying-Jun Chen , Ruo-Yan Wei , Xing-Tao Zhou

2021, 14(1):160-162. DOI: 10.18240/ijo.2021.01.22

[Abstract](1435) [HTML](0) [PDF 524.41 K](635)

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23 Endothelial keratoplasty combined with scleral fixation intraocular lens

Mariantonia Ferrara , Danilo Iannetta , Luca Pagano , Kunal A Gadhvi , Vito Romano

2021, 14(1):163-166. DOI: 10.18240/ijo.2021.01.23

[Abstract](811) [HTML](0) [PDF 861.39 K](614)

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24 Comment on “Impact of ultrasound and optical biometry on refractive outcomes of cataract surgery after penetrating keratoplasty in keratoconus”

Maddalena De Bernardo , Ferdinando Cione , Nicola Rosa

2021, 14(1):167-167. DOI: 10.18240/ijo.2021.01.24

[Abstract](653) [HTML](0) [PDF 283.51 K](571)

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25 Comment on “Early results of circularity and centration of capsulotomy prepared by three different methods”

Hesam Hashemian

2021, 14(1):168-168. DOI: 10.18240/ijo.2021.01.25

[Abstract](640) [HTML](0) [PDF 258.22 K](517)

Abstract:

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Volume 14,Issue 1,2021 Table of Contents