Volume 14,Issue 3,2021 Table of Contents

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    • 1  Protective effects of riboflavin-UVA-mediated posterior sclera collagen cross-linking in a guinea pig model of form-deprived myopia
    Ding Han ,  Mei-Nan He ,  Ying Zhu ,  Yan Zhang ,  Rui-Hua Wei
    2021, 14(3):333-340. DOI: 10.18240/ijo.2021.03.01
    [Abstract](1116) [HTML](0) [PDF 1.37 M](871)
    Abstract:
    AIM: To evaluate the effect of posterior sclera collagen cross-linking induced by riboflavin-ultraviolet A (UVA) on form-deprived myopia in guinea pigs. RESULTS: After 4wk, the interocular difference of refractive error were -0.11±0.67, -2.93±0.56, 1.10±0.58, and -1.63±0.41 D in the NOR, FDM, NOR+CL, and FDM+CL groups respectively. Mixed-effect linear model revealed significant effect of FDM (P<0.01) and CL (P<0.001). Also, after 4wk, the interocular difference of axial length were 0.01±0.04, 0.29±0.07, -0.13±0.06, and 0.11±0.05 mm in the NOR, FDM, NOR+CL, and FDM+CL group. Mixed-effect linear model revealed significant effect of FDM (P<0.001) and CL (P<0.01). As for corneal curvature, significant interocular difference have not found between any of the two groups. At the end of this experiment, the ultimate stress and elastic modulus were found significantly increased in both CL groups. But no difference was found in the groups without cross-linked. There was no abnormality observed in the retina and RPE cells of the treated eyes. CONCLUSION: The posterior sclera collagen cross-linking induced by riboflavin-UVA can slow down the progress of myopia and increase the sclera biomechanical strength in the guinea pig model of form-deprived myopia.
    2  Effect of zymosan on the expression and function of the gap-junction protein connexin 43 in human corneal fibroblasts
    Xiao-Shuo Zheng ,  Hui Zheng ,  Dan Xu ,  Ping-Ping Liu ,  Bing Li ,  Zi-Mu Cao ,  Yang Liu ,  Ye Liu
    2021, 14(3):341-348. DOI: 10.18240/ijo.2021.03.02
    [Abstract](894) [HTML](0) [PDF 1.91 M](713)
    Abstract:
    AIM: To study the effect of zymosan, a ligand found on the surface of fungi, on gap junctional intercellular communication (GJIC) in cultured human corneal fibroblasts (HCFs). METHODS: Zymosan was added to the medium of cultured HCFs with or without the administration of mitogen-activated protein kinase (MAPK) inhibitors or the inhibitor kappa B kinase 2 (IKK2) inhibitor IV. The protein and mRNA levels of connexin 43 (Cx43) in HCFs were measured by Western blot, immunofluorescence, and quantitative reverse transcription-polymerase chain reaction (qRT-PCR) analyses. The GJIC activity was tested using a dye-coupling assay. RESULTS: The reduction of Cx43 protein and mRNA levels as well as a significant decrease in GJIC activity were observed in cultured HCFs when zymosan was added into the culture medium. Compared with controls (no zymosan), the protein level of Cx43 was reduced by 45% and 54% in the presence of zymosan at 200 and 600 μg/mL, respectively (P<0.05); and it was reduced by 45%, 48%, and 75% in the presence of zymosan (600 μg/mL) for 24, 36, and 48h, respectively (P<0.05). The mRNA expression of Cx43 was reduced by 98% in the presence of zymosan (P<0.05). The effects of zymosan on Cx43 expression and GJIC activity were attenuated by the administration of PD98059 [an extracellular signal-regulated kinase (ERK) signaling inhibitor] (P<0.05), c-Jun NH2-terminal kinase (JNK) inhibitor II (P<0.05), and IKK2 inhibitor IV (P<0.05). CONCLUSION: Zymosan inhibits the activity of GJIC in cultured HCFs. This effect is likely regulated via the nuclear factor-κB (NF-κB), MAPK/ERK, and JNK signaling pathways. The inhibitory effects of zymosan on Cx43 expression and GJIC activity in HCFs may induce damage of corneal stroma during corneal fungal infection.
    3  LRG1 promotes epithelial-mesenchymal transition of retinal pigment epithelium cells by activating NOX4
    Li Zhou ,  De-Peng Shi ,  Wen-Juan Chu ,  Ling-Ling Yang ,  Hai-Feng Xu
    2021, 14(3):349-355. DOI: 10.18240/ijo.2021.03.03
    [Abstract](1304) [HTML](0) [PDF 1.12 M](863)
    Abstract:
    AIM: To investigate the effect of leucine-rich-alpha-2-glycoprotein 1 (LRG1) on epithelial-mesenchymal transition (EMT) in retinal pigment epithelium (RPE) cells, and to explore the role of NADPH oxidase 4 (NOX4). METHODS: RPE cells (ARPE-19 cell line) were treated with transforming growth factor-β1 (TGF-β1) to induce EMT. Changes of the mRNA and protein expression levels of LRG1 were tested in the TGF-β1 treated cells. The recombinant human LRG1 protein (rLRG1) and siRNA of LRG1 were used to establish accumulation of exogenous LRG1 model and the down-regulation of LRG1 model in ARPE-19 cells respectively, and to detect EMT-related markers including fibronectin, α-smooth muscle actin (α-SMA) and zonula occludens-1 (ZO-1). The mRNA and protein expression level of NOX4 were measured according to the above treatments. VAS2870 was used as a NOX4 inhibitor in rLRG1-treated cells. EMT-related markers were detected to verify the effect of NOX4 in the process of EMT. RESULTS: TGF-β1 promoted the expression of LRG1 at both the mRNA and protein levels during the process of EMT which showed the up-regulation of fibronectin and α-SMA, as well as the down-regulation of ZO-1. Furthermore, the rLRG1 promoted EMT of ARPE-19 cells, which manifested high levels of fibronectin and α-SMA and low level of ZO-1, whereas knockdown of LRG1 prevented EMT by decreasing the expressions of fibronectin and α-SMA and increasing the expression of ZO-1 in ARPE-19 cells. Besides, the rLRG1 activated and LRG1 siRNA suppressed NOX4 expression. EMT was inhibited when VAS2870 was used in the rLRG1-treated cells. CONCLUSION: These results for the first time demonstrate that LRG1 promotes EMT of RPE cells by activating NOX4, which may provide a novel direction to explore the mechanisms of subretinal fibrosis.
    4  Visual performance of four types of diffractive multifocal intraocular lenses and a review of articles
    Farideh Doroodgar ,  Feizollah Niazi ,  Azad Sanginabadi ,  Farid Karimian ,  Sana Niazi ,  Cyrus Alinia ,  Mohammad Ali Javadi
    2021, 14(3):356-365. DOI: 10.18240/ijo.2021.03.04
    [Abstract](1280) [HTML](0) [PDF 897.32 K](818)
    Abstract:
    AIM: To compare the clinical outcomes of a variety of multifocal intraocular lenses (MIOLs) in patients diagnosed with presbyopia or cataracts. METHODS: This clinical trial study included 141 patients (282 eyes) with different MIOLs implantation. The Symfony (60 eyes), the ReSTOR (100 eyes), the AT LISAtri (60 eyes), and the PanOptix (62 eyes) intraocular lenses were evaluated in this prospective interventional study. The near, intermediate, and distant visual acuities, contrast sensitivity, and defocus curve were measured as valid criteria. To statistically analyze the results, we used the Statistical Package for Social Science software, the non-parametric Wilcoxon signed-rank t, the one-way analysis of variance and the Tukey's post-hoc test in our analysis. Moreover, we conducted a detailed literature search on the PubMed database in English about MIOLs, in total 59 studies were included in this review article. RESULTS: The four approaches did not show any significant difference in the best-corrected distance visual acuity (P>0.05). The defocus curves at the contrast of 100% showed that trifocal IOLs had better intermediate performance than the bifocal IOL (P<0.05). There were no statistically significant differences between AT LISAtri and PanOptix lenses for visual acuity at all distances. The eyes with PanOptix, Symfony, and AT LISAtri IOL showed better contrast sensitivity than those ReSTOR at spatial frequencies of 1, 3, and 6 cpd in photopic and mesopic conditions (P<0.001). CONCLUSION: All four groups of the multifocal lenses were satisfying in terms of distance and near vision. Also, the group of trifocal lenses led to satisfactory outcomes in intermediate vision, without degradation in quality of vision.
    5  Efficacy of wet-lab training versus surgical-simulator training on performance of ophthalmology residents during chopping in cataract surgery
    Ya-Guang Hu ,  Qiu-Ping Liu ,  Ning Gao ,  Chang-Rui Wu ,  Jian Zhang ,  Li Qin ,  Jing-Ming Li
    2021, 14(3):366-370. DOI: 10.18240/ijo.2021.03.05
    [Abstract](960) [HTML](0) [PDF 453.29 K](656)
    Abstract:
    AIM: To analyze whether wet-lab training (WLT) or surgical-simulator training (SST) is better for ophthalmology residents to master the chopping technique. METHODS: Sixty ophthalmology residents (in their second year) and three cataract surgeons participated in the study. The residents were randomly separated into two groups, WLT group and SST group. The residents in WLT group were asked to perform 10 trials of chopping using pig eyes and scored by the surgeons, and then they performed and scored using simulator for one time. The residents in SST group underwent 10 trials of chopping using simulator, and the simulator scored each trail. Then, this group were asked to perform the chopping using pig eyes and scored by the surgeons. At last, we investigated the residents' satisfaction about the training. RESULTS: The demographic characteristics had no significant differences between the two groups. Recorded by the simulator, the residents in SST group got significantly higher overall score (83.90±1.31) than WLT group (78.73±1.92, P=0.03). And the residents in SST group got less corner area injured, and they spend less time than WLT group (P<0.05). Moreover, the residents in WLT group used more ultrasonic energy value than SST group (P=0.03). However, scored by the surgeons, the residents in two groups got nearly the same overall score. The residents in WLT group performed better on the frequencies of posterior capsule torn and incisional stress (P=0.03, 0.008, respectively). In the survey, the residents in two groups held the same opinion that the training was helpful and they strongly recommended this training. And all of them enjoyed the training, and enjoyed being randomized in their own group. However, with respect to the realistic character, the residents thought that WLT was better than SST (P<0.001). CONCLUSION: Both of the Eyesi surgical-stimulator and the wet-lab improve the residents' chopping ability and each has its own advantages. The combination of the two training ways could be considered to be a part of the training curriculum for new residents.
    6  Visual quality after implantation of trifocal intraocular lenses in highly myopic eyes with different axial lengths
    Hui Liu ,  Fang-Fang Li ,  Hai-Jun Xia ,  Jin Zhou
    2021, 14(3):371-377. DOI: 10.18240/ijo.2021.03.06
    [Abstract](1024) [HTML](0) [PDF 602.57 K](660)
    Abstract:
    AIM: To analyze postoperative clinical results after implantation of trifocal intraocular lenses (IOLs) in highly myopic eyes with different axial lengths (ALs). METHODS: This retrospective study describes 61 eyes of 44 patients that were implanted with trifocal diffractive IOLs (AT LISA tri 839MP). Twenty-one eyes (15 patients) were included in the AL<26 mm group, 19 eyes (13 patients) in the AL≥26 mm and <28 mm group, and 21 eyes (16 patients) in the AL≥28 mm group. Postoperative outcomes, including corrected and uncorrected distance visual acuity (UDVA), intermediate and near visual acuity at 167 cd/m2 luminance, depth of focus at 85 cd/m2 luminance, and objective optical quality parameters assessed using the Optical Quality Analysis System (OQAS), were compared among the groups at 3mo. RESULTS: There were no significant differences in the mean UDVA, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distance visual acuity, distance-corrected intermediate visual acuity, and distance-corrected near visual acuity (DCNVA) among the three groups (P>0.05). Better near and intermediate visual acuity (from -1.5 D to -3.0 D) were noted on the defocus curve of the AL<26 mm group (P<0.01 vs AL≥28 mm group). Significantly higher objective scatter index (OSI) values and lower modulation transfer function (MTF) cut-off values, Strehl ratio (SR), and OQAS values (OVs) were observed in the AL≥28 mm group (P<0.01 vs AL<26 mm group). All OQAS parameters had statistically significant correlations with DCNVA and visual acuity at the vergence of -2.5 D (P<0.05 to P<0.01). CONCLUSION: Implantation of trifocal IOLs provides good short-term visual and refractive outcomes in highly myopic eyes with different ALs. However, the near vision decreases in the extremely myopic eyes at lower luminance, which is associated with the lower objective optical quality in these eyes.
    7  Comparative evaluation of rotational stability of toric IOLs with four-eyelet vs two-eyelet capsular tension rings in eyes with high myopia
    Hui-Min Jiang ,  Kun Liang ,  Li-Ming Tao
    2021, 14(3):378-382. DOI: 10.18240/ijo.2021.03.07
    [Abstract](889) [HTML](0) [PDF 570.16 K](624)
    Abstract:
    AIM: To compare the rotational stability of Toric intraocular lens (IOLs) implantation combined with four-eyelet or two-eyelet capsular tension rings (CTRs) in eyes with high myopia and cataract. METHODS: This prospective randomized controlled interventional study included 33 eyes which had preoperative corneal astigmatism ≥1.5 D and ocular axial length ≥25.5 mm. These eyes were randomly divided into two groups to undergo phacoemulsification and toric IOL implantation with either four-eyelet CTR implantation (group A, n=16) or two-eyelet CTR implantation (group B, n=17). Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), phoropter examination results, and toric IOL rotation degrees were tested 6mo after the surgery. RESULTS: In both groups, the toric IOL was in the capsular sac 6mo after surgery. The difference between the two groups in terms of visual outcome was not found to be statistically significant (P>0.05) at a follow-up of 6mo. The mean residual astigmatism values were 0.56±0.22 D and 0.92±0.24 D in A and B groups, respectively (P<0.001). The mean rotation degree of IOL was 1.00°±0.73° in group A and 3.53°±1.46° in group B (P<0.001). CONCLUSION: In cataract patients with high myopia and astigmatism, four-eyelet CTR can effectively increase the rotation stability of toric IOLs, achieving the desired goal of correcting corneal astigmatism.
    8  An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy
    Faried Wagdy ,  Tharwat H. Mokbel ,  Hisham Elsorogy ,  Ahmed Alnagdy ,  Dina Abd Elfattah ,  Abd-Elmonem A. Elhesy
    2021, 14(3):383-387. DOI: 10.18240/ijo.2021.03.08
    [Abstract](642) [HTML](0) [PDF 642.63 K](570)
    Abstract:
    AIM: To compare the outcome of an Ex-Press implant and subscleral trabeculectomy (SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb. METHODS: This randomized prospective study included 28 eyes from 28 patients (age range: 42-55y) with primary open angle glaucoma (POAG) presented with elevated intraocular pressure (IOP) with fibrotic bleb despite previous SST for more than 4mo. The eyes enrolled in the study were divided into two groups: group I (subjected to Ex-Press implant surgery) and group II [subjected to SST with mitomycin C (MMC)]. The follow-up continued one year after surgery to evaluate IOP, visual acuity (VA), visual field (VF), and postoperative complications. RESULTS: A significant decrease in IOP was found in both groups with a higher reduction in Ex-Press implant surgery with the mean IOP of 14.50 mm Hg (P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg (P=0.001) after one year. However, the difference between the two groups in terms of the decrease in IOP was insignificant. Fewer postoperative complications were recorded in the Ex-Press implant surgery and more cases requiring further anti-glaucomatous medications were seen in the SST group. Both groups showed stability in terms of VA and VF. CONCLUSION: Ex-Press implant surgery and SST with MMC are two surgical alternatives for controlling IOP in late failure that occurs more than 4mo after previous SST with a fibrotic bleb. However, Ex-Press shunt is a safer surgery with fewer complications.
    9  Micropulse laser trabeculoplasty under maximal tolerable glaucoma eyedrops: treatment effectiveness and impact of surgical expertise
    Shinji Kakihara ,  Takao Hirano ,  Akira Imai ,  Taihei Kurenuma ,  Yoshiaki Chiku ,  Toshinori Murata
    2021, 14(3):388-392. DOI: 10.18240/ijo.2021.03.09
    [Abstract](763) [HTML](0) [PDF 417.19 K](730)
    Abstract:
    AIM: To evaluate the effectiveness of micropulse laser trabeculoplasty (MLT) for eyes with open angle glaucoma (OAG) under maximal tolerable glaucoma eyedrops and to assess the effect of expertise performing MLT on its clinical effectiveness. METHODS: Medical records of 42 consecutive eyes of 34 patients diagnosed with OAG who underwent MLT were retrospectively reviewed. The effectiveness was determined using the Kaplan-Meier survival analysis. Failure was defined as an intraocular pressure (IOP) reduction of <20% from baseline, an IOP >21 mm Hg during two consecutive follow-up visits, or surgical intervention for OAG. To determine the impact of MLT surgical expertise on clinical effectiveness, the eyes were divided into two groups according to whether the procedure was conducted by an experienced specialist (defined as a glaucoma specialist who had conducted at least ten MLT procedures) or a less experienced glaucoma specialist. The difference in expertise was determined using a log-rank test. RESULTS: MLT was conducted by three glaucoma specialists. The overall survival rates were 0.76, 0.48, and 0.44 at 1, 3, and 6mo, respectively. The survival rates for MLT performed by a less experienced glaucoma specialist were 0.62, 0.31, and 0.25 (n=21 eyes) at 1, 3, and 6mo, respectively, whereas the survival rates for MLT performed by an experienced glaucoma specialist were 0.90, 0.64, and 0.64 (n=21 eyes) at 1, 3, and 6mo, respectively. The log-rank test showed a significant difference in the survival curves of the two groups (P=0.0061). CONCLUSION: The 6-month effectiveness of MLT for controlling IOP is relatively limited in eyes with OAG using maximal tolerable glaucoma eyedrops. However, its effectiveness may be improved if performed by a glaucoma specialist with sufficient MLT experience.
    10  High interpretable machine learning classifier for early glaucoma diagnosis
    Carlos Salvador Fernandez Escamez ,  Elena Martin Giral ,  Susana Perucho Martinez ,  Nicolas Toledano Fernandez
    2021, 14(3):393-398. DOI: 10.18240/ijo.2021.03.10
    [Abstract](932) [HTML](0) [PDF 547.94 K](690)
    Abstract:
    AIM: To develop a classifier for differentiating between healthy and early stage glaucoma eyes based on peripapillary retinal nerve fiber layer (RNFL) thicknesses measured with optical coherence tomography (OCT), using machine learning algorithms with a high interpretability. METHODS: Ninety patients with early glaucoma and 85 healthy eyes were included. Early glaucoma eyes showed a visual field (VF) defect with mean deviation >-6.00 dB and characteristic glaucomatous morphology. RNFL thickness in every quadrant, clock-hour and average thickness were used to feed machine learning algorithms. Cluster analysis was conducted to detect and exclude outliers. Tree gradient boosting algorithms were used to calculate the importance of parameters on the classifier and to check the relation between their values and its impact on the classifier. Parameters with the lowest importance were excluded and a weighted decision tree analysis was applied to obtain an interpretable classifier. Area under the ROC curve (AUC), accuracy and generalization ability of the model were estimated using cross validation techniques. RESULTS: Average and 7 clock-hour RNFL thicknesses were the parameters with the highest importance. Correlation between parameter values and impact on classification displayed a stepped pattern for average thickness. Decision tree model revealed that average thickness lower than 82 µm was a high predictor for early glaucoma. Model scores had AUC of 0.953 (95%CI: 0.903- 0998), with an accuracy of 89%. CONCLUSION: Gradient boosting methods provide accurate and highly interpretable classifiers to discriminate between early glaucoma and healthy eyes. Average and 7-hour RNFL thicknesses have the best discriminant power.
    11  Comparing posture induced intraocular pressure variations in normal subjects and glaucoma patients
    Onyekachi Jane Ireka ,  Chimdia E Ogbonnaya ,  Obinna C Arinze ,  Nneka Ogbu ,  Chimdi M Chuka-Okosa
    2021, 14(3):399-404. DOI: 10.18240/ijo.2021.03.11
    [Abstract](796) [HTML](0) [PDF 516.13 K](694)
    Abstract:
    AIM: To compare the posture-induced variations in intraocular pressure (IOP) between the primary open angle glaucoma (POAG) and non-glaucomatous eyes. METHODS: A case-controlled age matched study was conducted in 55 successive newly diagnosed POAG and 56 non-glaucomatous patients seen in glaucoma clinic and general outpatient eye clinic in the Alex Ekwueme University Teaching Hospital, Abakaliki. The IOPs of eligible correspondents were measured with Perkin's hand-held tonometer in the sitting, supine flat and supine with pillow positions respectively. Measurement of IOP in each position was done after 15min of assuming such posture. RESULTS: The IOP difference between the sitting and supine flat position was significantly higher in the POAG than non-glaucoma subjects (7.68±2.08 vs 4.03±0.13 mm Hg, P<0.001). The IOP difference between the sitting and supine with pillow positions was 2.61±1.49 mm Hg for POAG and 1.44±0.70 mm Hg in non-glaucoma (P<0.001), while difference between supine flat and supine with pillow positions was 5.07±2.24 mm Hg in POAG and 2.59±0.66 mm Hg in non-glaucomatous patients (P<0.001). CONCLUSION: Greater variations in posture induced IOP occurred in POAG patients than non-glaucomatous. The posture induced IOP variation is lowest in the sitting position and highest in the supine flat position. Evaluation of posture induced IOP changes may be an important tool in the management of glaucoma.
    12  Role of home monitoring with iCare ONE rebound tonometer in glaucoma patients management
    Eldar Rosenfeld ,  Gilad Rabina ,  Dana Barequet ,  Michael Mimouni ,  Naomi Fischer ,  Shimon Kurtz
    2021, 14(3):405-408. DOI: 10.18240/ijo.2021.03.12
    [Abstract](691) [HTML](0) [PDF 494.68 K](606)
    Abstract:
    AIM: To evaluate intraocular pressure (IOP) measurements and fluctuations using the iCare ONE rebound tonometer (RT-ONE), during home monitoring, in diagnosed and suspected glaucoma patients. METHODS: A retrospective case series of consecutive patients with known glaucoma or glaucoma suspects who were followed-up and treated between January 2016 and January 2017. The study included 80 eyes of 40 patients with a mean age of 59.1±14.6y (range, 24-78). All patients have undergone 4-5d of IOP home monitoring with RT-ONE at morning, noon, afternoon, and night time. RESULTS: Baseline mean IOP, as measured in the clinic (8 a.m.-12 p.m.), was 17.4±5.1 mm Hg, compared to RT-ONE home monitoring mean IOP of 15.6±4.1 mm Hg (P=0.002). Mean IOP was significantly lower at noon, afternoon and night times compared to clinic measured IOP and morning measurements (P=0.005). IOP peak measured during home monitoring was significantly higher compared to the clinic measured IOP (21.3±5.6 mm Hg and 17.4±5.1 mm Hg, P<0.001). IOP peaks during home monitoring demonstrated a majority of 47 peaks during morning measurements, compared to 23 at noon, 19 at afternoon and only 12 at night (P<0.001). The home monitoring results led to treatment modification of 44 eyes (55%), treatment regime was insufficient for 40 (50%) eyes. CONCLUSION: Home monitoring IOP with RT-ONE can provide good assessment of mean IOP, IOP fluctuations and peaks throughout the hours of the day, which lead to an accurate treatment for glaucoma patients.
    13  Dynamic versus static ultra-widefield fluorescein angiography in eyes with diabetic retinopathy: a pilot prospective cross-sectional study
    Hang-Qi Shen ,  Jing Wang ,  Tian Niu ,  Ji-Li Chen ,  Xun Xu
    2021, 14(3):409-415. DOI: 10.18240/ijo.2021.03.13
    [Abstract](889) [HTML](0) [PDF 972.61 K](750)
    Abstract:
    AIM: To analyze differences in ultra-widefield fluorescein angiography (UWFA) findings between dynamic and static images of eyes with diabetic retinopathy (DR). METHODS: This cross-sectional study included 28 eyes of 28 patients with DR undergoing UWFA. A series of UWFA images acquired from each patient were converted into a time-lapse video and used as a dynamic image. A single, clear, arteriovenous phase image was chosen as a static image. Non-perfusion index (NPI) and its correlation with vascular abnormalities in different zones were compared between dynamic and static UWFA imaging. RESULTS: NPI appeared to increase from the center to the far-periphery in both groups. Dynamic NPI was lower in the total retinal area (0.26 vs 0.29, P=0.009) and far-periphery (0.33 vs 0.36, adjusted P=0.042), which was contrary to the static NPI. Far-peripheral NPI was associated with intraretinal microvascular abnormality in the posterior area in both groups. CONCLUSION: Time-lapse dynamic UWFA imaging is a useful modality to differentially diagnose hypofluorescence in the most peripheral region. This modality could provide a reliable method for NPI measurement.
    14  Real-world outcomes of two-year Conbercept therapy for diabetic macular edema
    Yong Cheng ,  Li Yuan ,  Ming-Wei Zhao ,  Tong Qian
    2021, 14(3):416-422. DOI: 10.18240/ijo.2021.03.14
    [Abstract](951) [HTML](0) [PDF 986.48 K](621)
    Abstract:
    AIM: To evaluate the two-year outcomes of patients treated for diabetic macular edema (DME) with intravitreal Conbercept (IVC). METHODS: The clinical data of 30 DME patients (36 eyes) were retrospectively reviewed. The patients were treated with IVC for 3mo. Additional IVC was given at subsequent monthly visits, if needed (3+PRN). The patients were followed up for 24mo. RESULTS: The best-corrected visual acuity (BCVA) at 24mo significantly increased (66.7±15.3 letters) in comparison with the baseline (54.4±15.4 letters, P<0.0001). The mean improvement in BCVA was 11.0±2.9 letters. At 24mo, 44.1% of the eyes surveyed gained ≥15 letters, 52.9% of the eyes gained ≥10 letters, and 70.6% of the eyes gained ≥5 letters. No vision loss was noted in 96.8% of the eyes, and 5.9% of the eyes lost ≥5 letters, but ≤10 letters. The central retinal thickness (CRT) at 24mo was significantly reduced (277.1±122.9 μm) in comparison with the baseline (510.9±186.1 μm, P<0.0001). At 24mo, 43.3% of the patients had a CRT ≤250 μm. The mean number of injections over 24mo was 10.6±2.0. No severe eye or systemic adverse events related to either the drug or injection were noted. CONCLUSION: IVC is safe and effective for the treatment of DME.
    15  Early visual function outcomes of topography-guided FS-LASIK and SMILE in treatment of myopia and myopic astigmatism
    Lin-Juan Yang ,  Xuan Liu ,  Sheng-Jian Mi ,  Le Sun ,  Meng-Xin Chen
    2021, 14(3):423-429. DOI: 10.18240/ijo.2021.03.15
    [Abstract](1033) [HTML](0) [PDF 767.37 K](635)
    Abstract:
    AIM: To compare the quality outcomes of vision at early phase after topography-guided femtosecond laser-assisted in situ keratomileusis (FS-LASIK-CV) and small incision lenticule extraction (SMILE) in treatment of myopia and myopic astigmatism. METHODS: Retrospective comparative analysis of 49 patients that underwent FS-LASIK (n=23) or SMILE (n=26) procedure for myopia and myopic astigmatism between April and September in 2019. Pre- and postoperative uncorrected visual acuity (UCVA), spherical equivalent refraction (SEQ), cylindrical refraction, contrast sensitivity function (CSF), and corneal higher-order aberrations (HOAs) were evaluated. Independent t-test was used for inter-group comparison, while repeated measures ANOVA was used to analyze changes at different time points. RESULTS: In both groups, 100% of the eyes obtained a UCVA of 20/20 or better at 1wk, 1, and 3mo postoperatively. At 1d and 3mo postoperatively, UCVA was better in FS-LASIK-CV group than in SMILE group. At 1wk postoperatively, SEQ was lower in SMILE group than in FS-LASIK-CV group (P=0.006). At 3mo postoperatively, the SEQ reached target refraction in both groups. The residual astigmatism was reduced in both groups without intergroup difference (P>0.05). At 3mo postoperatively, the spherical aberration and coma under 6 mm pupil size were higher than preoperative levels in both groups (P<0.05). However, the increase in the corneal HOAs in the FS-LASIK-CV group was less than the SMILE group (P<0.05). At 3mo postoperatively, the logCS were better than preoperative levels under scotopic conditions without glare and scotopic conditions with glare in both groups (P<0.05). At 1 and 3mo postoperatively, under scotopic conditions without glare and scotopic conditions with glare, FS-LASIK-CV group showed more improvement in logCS at two spatial frequencies (12.0 c/d and 18.0 c/d; P<0.05). CONCLUSION: Both FS-LASIK-CV and SMILE demonstrate to be safe, effective, and predictable in treatment of myopia and myopic astigmatism. Early postoperative improvement in UCVA and CSF at high spatial frequency under scotopic conditions were better after FS-LASIK-CV than SMILE.
    16  Comparison of healing patterns of different side-cut angulations after FS-LASIK
    Wei Wei ,  Xi-Yu Sun ,  Di Shen ,  Xiao-Rui Wang ,  Yu-Qiang Ji ,  Chang-Ning Zhang
    2021, 14(3):430-435. DOI: 10.18240/ijo.2021.03.16
    [Abstract](925) [HTML](0) [PDF 957.79 K](637)
    Abstract:
    AIM: To investigate and evaluate healing patterns around flaps made with different side-cut angulations after femtosecond laser in situ keratomileusis (FS-LASIK). METHODS: Thirty-four patients (68 eyes) received a 90° side-cut (n=34) or a 120° side-cut flaps (n=34) made with a femtosecond laser. One day, 1wk, 1 and 3mo postoperatively, side-cut scar was evaluated under slit-lamp photography according to a new grading system (Grade 0=transparent scar, 1=faint healing opacity, and 2=evident healing opacity). In vivo corneal confocal microscopy and anterior segment optical coherence tomography (AS-OCT) were used to observe wound-healing patterns around flap margin in the two groups. Sirius Scheimpflug Analyzer was also used to analyze higher order aberrations 3mo after surgery. RESULTS: There were no significant differences in flap wound-healing patterns at each follow up between the two groups (P>0.05). Three months after surgery, the flap edge scar classified as Grade 0 had excellent apposition and rapid nerve regeneration. At 3 mm and 5 mm pupil diameters, there were significant differences in trefoil aberrations between the two groups (P<0.05), but no statistically significant differences were found in total higher order aberrations (HOAs), spherical aberrations or coma in any of the pupil size conditions (P>0.05). CONCLUSION: Flap edge scars classified as Grade 0 have excellent apposition and rapid nerve regeneration, and 120° side-cut angle flaps induce less trefoil aberrations after FS-LASIK.
    17  Auricular cartilage versus donor sclera as a wrapping of hydroxyapatite orbital implants
    Ying-Jie Ma ,  Xiu-Ying Zhu ,  Ben Chen ,  Yan-Yan Lin ,  Jia Liu ,  Xi Chen
    2021, 14(3):436-441. DOI: 10.18240/ijo.2021.03.17
    [Abstract](798) [HTML](0) [PDF 1.17 M](679)
    Abstract:
    AIM: To retrospectively compare postoperative outcomes after primary enucleation and placement of a hydroxyapatite (HA) implant without wrapping, wrapped with auricular cartilage or donor sclera. METHODS: Medical records of patients presented as intraocular tumor or severe ocular injury were identified from the electronic medical record system. Cases underwent enucleation and HA orbital implantation were enrolled in this study and were divided into 3 groups according to the wrapping material of HA implant. Cases with autogenous cartilage caps were enrolled in group A (n=11), with donor sclera caps in group B (n=12), and without any wrapping material in group C (n=9). Follow-ups were set at 1, 2wk, 1, 3, 6, and 12mo after surgery. RESULTS: Altogether 32 cases finished the follow-up and were enrolled in this study. Three cases (27.27%) in group A, 4 cases (33.33%) in group B, and 4 cases (44.44%) in group C developed one complication each after surgery. In group A, no HA exposure occurred, but conjunctival inclusion cyst occurred in one and severe conjunctive chemosis in two cases. In group B, one HA exposure occurred, conjunctive inclusion cysts occurred in one, severe conjunctive chemosis occurred in one, and conjunctival granuloma occurred in one case. In group C, one HA exposure occurred, severe conjunctive chemosis occurred in two cases, and conjunctival granuloma occurred in one case. The case of exposure of none-wrapped implant was noted in the first 6mo after placement of the orbital implant. The case of exposure of donor sclera-wrapped implant was noted at the 12mo after placement of the orbital implant. Both exposure cases were treated successfully with conservative treatment. CONCLUSION: With low incidence of implant exposure and mild complications, auricular cartilage can be a good choice of alternative wrapping material of orbit implant with satisfied outcome.
    18  Quality of life in adult intermittent exotropia and the risk factors
    Bo-Wen Zhao ,  Jing Fu ,  Jing-Hui Wang ,  Hai-Xia Bai ,  Pei-Pei Liu ,  Ya-Nan Guo ,  Rong-Han Zhang ,  Han Su
    2021, 14(3):442-447. DOI: 10.18240/ijo.2021.03.18
    [Abstract](910) [HTML](0) [PDF 374.06 K](702)
    Abstract:
    AIM: To study the quality of life of adult patients with intermittent exotropia (IXT) in China and analyze the factors affecting the quality of life in IXT patients. METHODS: Totally 109 cases of normal eye (control group), 77 cases of IXT (IXT group) and 115 cases of strabismus control group (except IXT) were collected. The quality of life of the patients was assessed by Chinese version of adult strabismus patient's quality of life scale (CAS-20). The differences of general characteristics, visual function and quality of life were analyzed, and the effects of individual factors and visual function on quality of life of patients with IXT were analyzed. RESULTS: The IXT group had a high proportion of patients with family history, low proportion of patients with amblyopia compared with strabismus control group. The proportion with normal near and far stereopsis of IXT group were lower than that of normal control group. The best corrected visual acuity of IXT group was higher than that of strabismus control group, but lower than the control group. In addition, the median strabismus degree in IXT group was higher than that in other strabismus control group. The median psychosocial scores and median visual function scores of the IXT group was lower than that of the normal control group, but not different from strabismus control group. Occupation status, course of disease, far stereopsis and near stereopsis significantly affected the quality of life in IXT patients. CONCLUSION: Adult IXT patients in China have a certain proportion of family history and lower quality of life, The main factors affecting the quality of life of IXT patients is stereopsis, course of disease and occupation status.
    19  Corneal stromal mesenchymal stem cells: reconstructing a bioactive cornea and repairing the corneal limbus and stromal microenvironment
    Xian-Ning Liu ,  Sheng-Li Mi ,  Yun Chen ,  Yao Wang
    2021, 14(3):448-455. DOI: 10.18240/ijo.2021.03.19
    [Abstract](1219) [HTML](0) [PDF 371.34 K](849)
    Abstract:
    Corneal stroma-derived mesenchymal stem cells (CS-MSCs) are mainly distributed in the anterior part of the corneal stroma near the corneal limbal stem cells (LSCs). CS-MSCs are stem cells with self-renewal and multidirectional differentiation potential. A large amount of data confirmed that CS-MSCs can be induced to differentiate into functional keratocytes in vitro, which is the motive force for maintaining corneal transparency and producing a normal corneal stroma. CS-MSCs are also an important component of the limbal microenvironment. Furthermore, they are of great significance in the reconstruction of ocular surface tissue and tissue engineering for active biocornea construction. In this paper, the localization and biological characteristics of CS-MSCs, the use of CS-MSCs to reconstruct a tissue-engineered active biocornea, and the repair of the limbal and matrix microenvironment by CS-MSCs are reviewed, and their application prospects are discussed.
    20  Intracameral anti-VEGF injection for advanced neovascular glaucoma after vitrectomy with silicone oil tamponade
    Ling Bai ,  Farheen Tariq ,  Yi-Dan He ,  Shu Zhang ,  Feng Wang
    2021, 14(3):456-460. DOI: 10.18240/ijo.2021.03.20
    [Abstract](1039) [HTML](0) [PDF 918.43 K](770)
    Abstract:
    AIM: To evaluate the effect of intracameral injection of conbercept for the treatment of advanced neovascular glaucoma (NVG) after vitrectomy with silicone oil tamponade. METHODS: Conbercept 0.5 mg/0.05 mL was injected into the anterior chamber of 5 eyes, which had developed advanced NVG after vitrectomy with silicone oil tamponade. Then, trabeculectomy with mitomycin C and pan-retinal photocoagulation (PRP) or extra-PRP were conducted within 2d. The follow-up time was 6mo. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), neovascularization of iris (NVI) were recorded before and after treatment. RESULTS: Within 2d after injection, IOP control, and NVI regression were optimal for trabeculectomy. Hyphema occurred in one eye in the process of injection. But none of them present hyphema after trabeculectomy. At the end of follow-up time, all eyes had improved BCVA, well-controlled IOP, and completely regressed NVI. CONCLUSION: Intracameral injection of conbercept is safe and effective in the treatment of patients with advanced NVG after vitrectomy with silicone oil tamponade. Within 2d after injection is the optimal time window for trabeculectomy, which can maximally reduce the risk of perioperative hyphema.
    21  Clinical observations of acute onset of myopic optic neuropathy in a real-world setting
    Li Liao ,  Rui Fang ,  Fang Fang ,  Xiao-Hua Zhu
    2021, 14(3):461-467. DOI: 10.18240/ijo.2021.03.21
    [Abstract](856) [HTML](0) [PDF 1.49 M](634)
    Abstract:
    AIM: To describe the clinical features of acute myopic onset of optic neuropathy and observe the effects of retrobulbar and systemic glucocorticoid therapy in a real-world setting. METHODS: A retrospective observational case series included 18 patients with a clinical diagnosis of acute onset of myopic optic neuropathy in a real-world setting. While the patients were using retrobulbar and systemic glucocorticoid therapy, various imaging examination data were analysed, and the clinical features of myopic optic neuropathy were summarized for 6mo to 2y. RESULTS: The included group of patients with acute onset of myopic optic neuropathy consisted mostly of females (n=11). The visual field (VF) showed abnormalities in bilateral eyes, including the spread of physiological blind spots, central and paracentral dark spots, and centripetal peripheral VF reduction; but central vision with no subjective changes. The visual evoked potential (VEP) was abnormal in all eyes with vision loss. The best corrected visual acuity (BCVA) was improved from 1.04±0.63 to 0.47±0.57 (logMAR) after glucocorticoid treatment (P<0.05). In patients with a short course (within 1wk), recovery was fast and achieved the same BCVA as recorded before the onset within 6d. However, in patients with the long course (1 to 2wk), recovery was slow and did not achieve the BCVA recorded before the onset within 10d. The changes of intraocular pressure (IOP) were not obvious before and after treatment (18.68±5.30 vs 19.55±5.34 mm Hg, P>0.05). There was no recurrence during long-term follow-up observation. CONCLUSION: The acute onset of myopic optic neuropathy is characterized by BCVA and VF abnormalities in bilateral eyes. Retrobulbar and systemic glucocorticoid therapy is effective.
    22  Long-term hemodialysis improved and stabilized diabetic macular edema: two case reports
    Wei Fan ,  Rong-Di Yuan
    2021, 14(3):472-475. DOI: 10.18240/ijo.2021.03.23
    [Abstract](808) [HTML](0) [PDF 1.66 M](543)
    Abstract:
    23  Acute corneal graft rejection following photorefractive keratectomy for post-penetrating keratoplasty high astigmatism
    Leopoldo Spadea ,  Maria Ilaria Giannico ,  Marta Armentano ,  Ludovico Alisi ,  Santino Pistella
    2021, 14(3):476-477. DOI: 10.18240/ijo.2021.03.24
    [Abstract](721) [HTML](0) [PDF 600.00 K](537)
    Abstract:
    24  Unilateral disc edema as the first presentation of chronic myeloid leukemia
    Suzie Gasparian ,  Eman Hawy
    2021, 14(3):478-480. DOI: 10.18240/ijo.2021.03.25
    [Abstract](579) [HTML](0) [PDF 1.10 M](610)
    Abstract:
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