Volume 14,Issue 6,2021 Table of Contents

1 Dr. Father Waclaw Szuniewicz, a forgotten pioneer in refractive surgery and his work in China

Piotr Kanclerz , Andrzej Grzybowski

2021, 14(6):791-794. DOI: 10.18240/ijo.2021.06.01

[Abstract](1019) [HTML](0) [PDF 1.42 M](743)

Abstract:
Father Wac?aw Szuniewicz (1891-1963) was a skilled ophthalmic surgeon, missionary, and teacher. For several years he worked in China, afterwards in the United States and in Brazil. The aim of the paper is to present the unanalyzed issues of Szuniewicz’s research regarding corneal refractive surgery. Szuniewicz performed experiments on changing the corneal curvature with anterior, posterior and full-thickness incisions. The results of modifying the anterior and posterior corneal curvature were satisfactory, however, diminished significantly within months after surgery. Corneal band resections were superior in terms of efficacy, however, such an intervention commonly led to complications in animal studies. Szuniewicz’s work was not published during his life. Nevertheless, as a result of strong impact of his personality and ideas, he is frequently considered as a pioneer of corneal refractive surgery.

2 Deterioration of Avellino corneal dystrophy in a Chinese family after LASIK

Xue Jiang , Hong Zhang

2021, 14(6):795-799. DOI: 10.18240/ijo.2021.06.02

[Abstract](1045) [HTML](0) [PDF 1.06 M](700)

Abstract:
AIM: To reveal the importance of TGFBI gene screening for candidates with a family history of corneal disease or granular opacities in corneal stroma before refractive surgery. METHODS: A 37-year-old male (proband) underwent bilateral laser-assisted in situ keratomileusis (LASIK) in 2002, with right vision decreased significantly in 2006. The proband and other 32 members of the family underwent a detailed ophthalmic examination, including vision acuity, intraocular pressure, slit-lamp photograph, fundus examination, optical coherence tomography (OCT) of cornea, and in vivo confocal microscope (IVCM) and peripheral blood was used for genomic DNA extraction. Seventeen TGFBI gene exons were analyzed via polymerase chain reaction amplification and direct sequencing. RESULTS: Slit-lamp, IVCM, and OCT images showed that a large amount of dense and confluent granular opaque were seen at the interfaces of the flap and remnant stromal bed in right and light degree in left eye. Sanger sequencing showed that there was a 371G>A mutation (CGC>CAC) in exon 4, which indicated that he harbored a heterozygote R124H mutation, identifying the diagnosis of Avellino corneal dystrophy (ACD). Among the other 32 family members, 6 of them harbored the identical mutation to that in the proband. CONCLUSION: ACD will worsen and recur after LASIK. Preoperative gene-screening for TGFBI mutations is important in diagnosing ACD.

3 A mutated CRYGD associated with congenital coralliform cataracts in two Chinese pedigrees

Su-Ping Cai , Lan Lu , Xi-Zhen Wang , Yun Wang , Fen He , Ning Fan , Jing-Ning Weng , Jun-Hua Zhang , Xu-Yang Liu

2021, 14(6):800-804. DOI: 10.18240/ijo.2021.06.03

[Abstract](1066) [HTML](0) [PDF 710.26 K](746)

Abstract:
AIM: To investigate the causal gene mutation and clinical characteristics for two Chinese families with autosomal dominant congenital coralliform cataract. METHODS: Two Chinese pedigrees with congenital cataract were investigated. Routine ophthalmic examinations were performed on all patients and non-affected family members. Peripheral blood samples were collected, and the genomic DNAs were extracted. The coding regions of proband’s DNAs were analyzed with cataract gene panel. The identified mutation was amplified by polymerase chain reaction, and automated sequencing was performed in other members of two families to verify whether the mutated gene was co-segregated with the disease. RESULTS: Congenital coralliform cataract was inherited in an autosomal dominant mode in both pedigrees. For each family, more than half of the family members were affected. All patients presented with severe visual impairment after birth as a result of bilateral symmetric coralliform lens opacification. An exact the same defect in the same gene, a heterozygous mutation of c.70C>A (p. P24T) in exon 2 of γD-crystallin gene, was detected in both probands from each family. Sanger sequencing analysis demonstrated that the mutated CRYGD was co-segregated in these two families. CONCLUSION: A c.70C>A (p. P24T) variant in CRYGD gene was reconfirmed to be the causal gene in two Chinese pedigrees. It is known that mutated CRYGD caused most of the congenital coralliform cataracts, suggesting that the CRYGD gene is associated with coralliform congenital cataract.

4 Autophagy dysregulation mediates the damage of high glucose to retinal pigment epithelium cells

Qian Zhang , Hong-Song Li , Rong Li , Jun-Hui Du , Cong Jiao

2021, 14(6):805-811. DOI: 10.18240/ijo.2021.06.04

[Abstract](1339) [HTML](0) [PDF 2.21 M](895)

Abstract:
AIM: To observe the role and mechanism of autophagy in retinal pigment epithelial cell (RPE) damaged by high glucose, so as to offer a new idea for the treatment of diabetic retinopathy (DR). METHODS: ARPE-19, a human RPE cell line cultured in vitro was divided into the normal control (NC), autophagy inhibitor 3-methyladenine (3-MA), high-glucose (HG), and HG+3-MA groups. Cell viability was detected by CCK-8 assay and the apoptosis rate was measured by flow cytometry. The protein expressions of apoptosis markers, including Bax, Bcl-2, and Caspase-3, as well as autophagy marker including microtubule-related protein 1 light chain 3 (LC3), p62, and mechanistic target of rapamycin (mTOR) were detected by Western blotting. Autophagic flux was detected by transfection with Ad-mCherry-GFP-LC3B. RESULTS: Under high glucose conditions, the viability of ARPE-19 was decreased, and the apoptosis rate increased, the protein expressions of Bax, Caspase-3, and LC3-II/LC3-I were all increased and the expressions of Bcl-2, p62 and p-mTOR decreased, and autophagic flux was increased compared with that of the controls. Treatment with 3-MA reversed all these changes caused by high glucose. CONCLUSION: The current study demonstrates the mechanisms of cell damage of ARPE-19 through high glucose/mTOR/autophagy/apoptosis pathway, and new strategies for DR may be developed based on autophagy regulation to manage cell death of RPE cells.

5 Association of eleven single nucleotide polymorphisms with refractive disorders from Eskisehir, Turkey

Nadir Unlu , Ebru Erzurumluoglu Gokalp , Serap Arslan , Oguz Cilingir , Muzaffer Bilgin , Engin Yildirim , Huseyin Gursoy

2021, 14(6):812-817. DOI: 10.18240/ijo.2021.06.05

[Abstract](866) [HTML](0) [PDF 449.12 K](661)

Abstract:
AIM: To investigate relationship between refractive errors and eleven single nucleotide polymorphisms (SNPs) in HGF, GC, MFN1, GNB4, and VDR genes in Turkish population. METHODS: A group of 212 participants with myopia (n=91), hyperopia (n=45), and emmetropia (n=76) were investigated in this study. SNPs in HGF, GC, MFN1, GNB4 and VDR genes were studied by SnapShot technique. RESULTS: The patients in this study consists of 47 female/44 male (age: 23.47±4.30) patients with myopia, 20 female/25 male (age: 31.20±8.02) with hyperopia and 33 female/43 male (age: 25.22±6.60) with emmetropia. The genotype distribution of the rs7618348 polymorphism, which was the only statistically significant one between myopia and emmetropia group. The genotype distribution of the rs3819545, rs3735520, rs7041, and rs2239182 polymorphisms, which were statistically significant between hyperopia and emmetropia groups. CONCLUSION: The importance of genetic predisposition to refractive errors with respect to etiology of the disease is revealed. It is known that polymorphism studies may differ because of genetic diversity among populations so larger cohort studies are required in different populations to enlighten the etiology of the refractive errors.

6 Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilization

Andreas Bringmann , Martin Karol , Jan Darius Unterlauft , Thomas Barth , Renate Wiedemann , Leon Kohen , Matus Rehak , Peter Wiedemann

2021, 14(6):818-833. DOI: 10.18240/ijo.2021.06.06

[Abstract](1429) [HTML](0) [PDF 6.87 M](913)

Abstract:
AIM: To document with spectral-domain optical coherence tomography the morphological regeneration of the fovea after resolution of cystoid macular edema (CME) without and with internal limiting membrane (ILM) detachment and to discuss the presumed role of the glial scaffold for foveal structure stabilization. METHODS: A retrospective case series of 38 eyes of 35 patients is described. Of these, 17 eyes of 16 patients displayed foveal regeneration after resolution of CME, and 6 eyes of 6 patients displayed CME with ILM detachment. Eleven eyes of 9 patients displayed other kinds of foveal and retinal disorders associated with ILM detachment. RESULTS: The pattern of edematous cyst distribution, with or without a large cyst in the foveola and preferred location of cysts in the inner nuclear layer or Henle fiber layer (HFL), may vary between different eyes with CME or in one eye during different CME episodes. Large cysts in the foveola may be associated with a tractional elevation of the inner foveal layers and the formation of a foveoschisis in the HFL. Edematous cysts are usually not formed in the ganglion cell layer. Eyes with CME and ILM detachment display a schisis between the detached ILM and nerve fiber layer (NFL) which is traversed by Müller cell trunks. ILM detachment was also found in single eyes with myopic traction maculopathy, macular pucker, full-thickness macular holes, outer lamellar holes, and glaucomatous parapapillary retinoschisis, and in 3 eyes with Müller cell sheen dystrophy (MCSD). As observed in eyes with MCSD, cellophane maculopathy, and macular pucker, respectively, fundus light reflections can be caused by different highly reflective membranes or layers: the thickened and tightened ILM which may or may not be detached from the NFL, the NFL, or idiopathic epiretinal membranes. In eyes with short single or multiple CME episodes, the central fovea regenerated either completely, which included the disappearance of irregularities of the photoreceptor layer lines and the reformation of a fovea externa, or with remaining irregularities of the photoreceptor layer lines. CONCLUSION: The examples of a complete regeneration of the foveal morphology after transient CME show that the fovea may withstand even large tractional deformations and has a conspicuous capacity of structural regeneration as long as no cell degeneration occurs. It is suggested that the regenerative capacity depends on the integrity of the threedimensional glial scaffold for foveal structure stabilization composed of Müller cell and astrocyte processes. The glial scaffold may also maintain the retinal structure after loss of most retinal neurons as in late-stage MCSD.

7 Reliability of Chinese web-based ocular surface disease index questionnaire in dry eye patients: a randomized, crossover study

Xin-Mei Zhang , Lan-Ting Yang , Qing Zhang , Qing-Xia Fan , Can Zhang , Yue You , Chen-Guang Zhang , Tie-Zhu Lin , Ling Xu , Salissou Moutari , Jonathan E. Moore , Emmanuel E. Pazo , Wei He

2021, 14(6):834-843. DOI: 10.18240/ijo.2021.06.07

[Abstract](1355) [HTML](0) [PDF 2.15 M](955)

Abstract:
AIM: To assess the reliability of web-based version of ocular surface disease index in Chinese (C-OSDI) on clinically diagnosed dry eye disease (DE) patients. METHODS: A total of 254 Chinese participants (51% male, 129/254; mean age: 27.90±9.06y) with DED completed paper- and web-based versions of C-OSDI questionnaires in a randomized crossover design. Ophthalmology examination and DED diagnosis were performed prior to the participants being invited to join the study. Participants were randomly designated to either group A (paper-based first and web-based second) or group B (web-based first and paper-based second). Final data analysis included participants that had successfully completed both versions of the C-OSDI. Demographic characteristics, test-retest reliability, and agreement of individual items, subscales, and total score were evaluated with intraclass correlation coefficients (ICC), Spearman rank correlation, Wilcoxon test and Rasch analysis. RESULTS: Reliability indexes were adequate, Pearson correlation was greater than 0.8 and ICCs range was 0.827 to 0.982; total C-OSDI score was not statistically different between the two versions. The values of mean-squares fit statistics were very low compared to 1, indicating that the responses to the items by the model had a high degree of predictability. While comparing the favorability 72% (182/254) of the participants preferred web-based assessment. CONCLUSION: Web-based C-OSDI is reliable in assessing DED and correlation with the paper-based version is significant in all subscales and overall total score. Web-based C-OSDI can be administered to assess individuals with DED as participants predominantly favored online assessment.

8 Surgical outcomes in acute dacryocystitis patients undergoing endonasal endoscopic dacryocystorhinostomy with or without silicone tube intubation

Bo Yu , Yu Xia , Jia-Ying Sun , Qian Ye , Yun-Hai Tu , Guang-Ming Zhou , Wen-Can Wu

2021, 14(6):844-848. DOI: 10.18240/ijo.2021.06.08

[Abstract](1002) [HTML](0) [PDF 2.40 M](751)

Abstract:
AIM: To establish the necessity of silicone tube intubation in acute dacryocystitis (AD) patients undergoing endonasal endoscopic dacryocystorhinostomy (En-DCR). METHODS: Patients presenting with unilateral AD were randomly assigned to two treatment groups. En-DCR procedures were performed following lacrimal abscess formation, with the operation being performed with silicone intubation for patients in group B but not group A. Functional success was defined by an absence of additional AD episodes, no epiphora, and ostium patency as established via endoscopic evaluation or fluorescein irrigation. Operative success rates and demographic variables were compared between treatment groups. RESULTS: In total, 66 patients were analyzed in the present study (33 per group), with complete postoperative data having been successfully collected from 27 and 22 patients in group A and group B, respectively. All patients exhibited complete resolution of acute inflammation. Upon follow-up, granulation tissue was detected around the ostium at higher rates in group B (9/22, 40.9%) relative to group A (4/27, 14.8%). At the 12-month follow-up time point, patients in group A exhibited higher success rates (25/27, 92.6%) relative to patients in group B (20/22, 90.9%), but this difference was not significant. Cases of lacrimal passage reconstruction failure in both groups were attributed to excessive fibrous and/or granulation tissue formation proximal to the intranasal ostium. CONCLUSION: Given that these two operative approaches are associated with similar rates of operative success and in light of differences in granulation tissue formation, cost, and operative duration, these data do not support the routine silicone intubation of AD patients following En-DCR surgery.

9 Rectangular 3-snip punctoplasty versus punch punctoplasty with silicone intubation for acquired external punctal stenosis: a prospective randomized comparative study

Xin Cao , Zi-Zhong Hu , Ying Wu , Yu Song , Qing-Huai Liu

2021, 14(6):849-854. DOI: 10.18240/ijo.2021.06.09

[Abstract](770) [HTML](0) [PDF 454.64 K](686)

Abstract:
AIM: To evaluate the effectiveness of rectangular 3-snip punctoplasty versus punch punctoplasty via Kelly punch with silicone intubation for the management of acquired external punctal stenosis (AEPS). METHODS: A prospective, randomized, comparative study was performed on 123 eyes of 94 patients with AEPS. Patients were recruited into either group of rectangular 3-snip punctoplasty (group A) or group of punch punctoplasty with silicone intubation (group B). Outcomes measured were Munk score, grade of punctal stenosis, fluorescein dye disappearance time test (FDDT) and tear meniscus height (TMH) 6 and 12mo after surgery. RESULTS: Twelve months after surgery, Munk score, FDDT and TMH significantly decreased in both groups compared with the baseline (all P<0.05), and grade of punctal stenosis increased significantly (P<0.05). The grade of punctal stenosis, Munk score, FDDT and TMH were better in group B compared with group A at 6 or 12mo (all P<0.05). There was a positive correlation between TMH and Munk score (R=0.655, P<0.001). At the last followed-up, anatomical success was noted in 96.7% eyes in group A and 98.4% eyes in group B (P=0.613). CONCLUSION: Punch punctoplasty via Kelly punch with silicone intubation achieves better outcomes than rectangular 3-snip punctoplasty. The new technique is a simple, minimally invasive, with high anatomical and functional success in patients with AEPS.

10 Role of bevacizumab intraocular injection in the management of neovascular glaucoma

Fawaz Al Sarireh , Hamzeh Mohammad Alrawashdeh , Khalid Al Zubi , Khalil Al Salem

2021, 14(6):855-859. DOI: 10.18240/ijo.2021.06.10

[Abstract](948) [HTML](0) [PDF 399.79 K](600)

Abstract:
AIM: To assess the long-term effects of intraocular bevacizumab (Avastin) injections as an adjunctive drug to manage patients with neovascular glaucoma (NVG). METHODS: A retrospective study was conducted consisting of 34 eyes with secondary NVG caused by proliferative diabetic retinopathy (n=25), ischemic central retinal vein occlusion (n=8), and retinal ischemia resulting from persistent detachment (n=1) were managed by intraocular injections of bevacizumab (1.25 mg/0.05 mL), in addition to other treatments. The main outcome measure was the change in the degree of iris neovascularization. Secondary outcomes included intraocular pressure and the number of additional interventions or antiglaucoma medications administered after injection. RESULTS: All patients were followed-up for at least 12mo. At the last follow-up, complete regression of rubeosis irides was detectable in 13 (38.2%) eyes and incomplete regression in 21 eyes (61.8%). The mean intraocular pressure was 45.32±7.185 mm Hg at baseline and significantly decreased to 26.15±5.679 mm Hg at the last follow-up visit (P=0.000005). Patients received an average of 4.97 injections. As additional treatments, 12 eyes (35%) received laser photocoagulation and 6 eyes (18%) underwent retinocryopexy. No further treatment was needed in 16 eyes (47.1%). CONCLUSION: Intravitreal bevacizumab injection can have a favorable effect in controlling intraocular pressure and pain control in patients with NVG because it decreases the angiogenesis and helps to augment the results of conventional procedures. The primary cause of retinal ischemia should be always targeted.

11 Evaluation of retinal and choroidal changes in patients with Alzheimer’s type dementia using optical coherence tomography angiography

Ze-Bing Li , Zhong-Jing Lin , Na Li , Huan Yu , Yan-Lin Wu , Xi Shen

2021, 14(6):860-868. DOI: 10.18240/ijo.2021.06.11

[Abstract](1149) [HTML](0) [PDF 2.27 M](834)

Abstract:
AIM: To evaluate the changes in fundus parameters in patients with Alzheimer’s type dementia (ATD) using optical coherence tomography angiography (OCTA), to record flash electroretinograms (ERG) using the RETeval system and to explore changes in retinal function. METHODS: Twenty-nine patients with ATD and 26 age-matched normal subjects were enrolled. All subjects underwent OCTA scans to analyse the superficial retinal vessel parameters in the macular area, including the vessel length density, the vessel perfusion density and the area of foveal avascular zone (FAZ), as well as the choroidal thickness. The differences between the patients with ATD and the normal control group were compared and explored the relevant factors affecting vessel parameters. We also recorded the flash ERGs using the RETeval system and intended to explore changes in retinal function by analysing the ERG image amplitude in patients with ATD. RESULTS: The vessel parameters [Pvessel length density=0.005 and Pvessel perfusion density=0.006) and average choroid thickness (P<0.001) in the macular area of the ATD group was less than the control group. The FAZ area was statistically significantly enlarged in the ATD group (P<0.001). These parameters were correlated with the Mini-Mental State Examination (MMSE) score and the Montreal Cognitive Assessment (MoCA). CONCLUSION: Patients with ATD exhibit decreases in the parameters associated with fundus. In addition, these indicators significantly correlate with the MMSE score and the MoCA score. OCTA may be an adjunct tool with strong potential to track changes in the diagnosis and monitoring the progression of the disease.

12 Triamcinolone as an adjunct to the combination of anti-VEGF for the management of diabetic macular edema

Ying-Ying Yu , Yong Cheng , Li-Bin Chang , Hui-Ka Xia , Xiao-Xin Li

2021, 14(6):869-874. DOI: 10.18240/ijo.2021.06.12

[Abstract](991) [HTML](0) [PDF 1.06 M](660)

Abstract:
AIM: To assess the efficacy of intravitreal triamcinolone (IVTA) as an adjunct to the combination of anti-vascular endothelial growth factor (VEGF) for the management of diabetic macular edema (DME). METHODS: A total of 51 patients with visual disabilities causing by DME from two sites were retrospectively collected and assigned to two groups according to the therapeutic method: intravitreal conbercept (IVC) combined with focal laser (24 eyes) and IVC combined with focal laser and IVTA (27 eyes). Best-corrected visual acuity (BCVA), the required number of IVCs, central retinal thickness (CRT), the mean costs of treatment burden and safety were compared over 12mo. RESULTS: From baseline to month 1 through month 12, IVC combined with focal laser and IVTA improved the mean average change in BCVA superior to IVC combined with focal laser (+5.20 vs +2.71 letters). At month 12, 20.83% of the IVC combined with focal laser and 37.04% of IVC combined with focal laser and IVTA arms gained more than 10 BCVA letters. During the period, the mean CRT decreased significantly in the IVC combined with focal laser and IVTA arm (-245.9 μm) compared to the IVC combined with focal laser arm (-98.45 μm). The average of 6.45 and 1.25 conbercept injections performed in the IVC combined with focal laser and IVC combined with focal laser and IVTA arms, respectively. The mean cost of treatment burden for 12mo was $6247.44±4069.18 in the IVC combined with focal laser arm and $1679.19±542.73 in the IVC combined with focal laser and IVTA arm, with a statistically significant difference. Apart from occasional minor subconjunctival hemorrhage, no other significant ocular adverse events (AEs) were observed in either group during the12-month period. CONCLUSION: It is effective and cost-effective to treat DME by utilizing triamcinolone as an adjunct to the combination of anti-VEGF.

13 A decrease in macular microvascular perfusion after retinal detachment repair with silicone oil

Wei Fang , Jing Zhai , Jian-Bo Mao , Hai-Dong Li , Zhen-Bin Qian , Chao-Qiao Chen , Jia-Hao Xu , Li-Jun Shen , Yi-Qi Chen

2021, 14(6):875-880. DOI: 10.18240/ijo.2021.06.13

[Abstract](804) [HTML](0) [PDF 419.00 K](621)

Abstract:
AIM: To observe whether silicone oil (SO) tamponade could decrease macular perfusion after retinal detachment repair. METHODS: A prospective observational case-control study. Patients diagnosed with primary macular off rhegmatogenous retinal detachment undergoing successful retinal repair surgery with vitrectomy were strictly selected. Optical coherence tomography angiography findings were compared between SO and air tamponade groups. Two postoperative visiting points were set (1 and 3mo). RESULTS: Totally 29 patients (29 eyes) were enrolled. Twenty cases had SO tamponade while 9 cases were with air tamponade. At the first visiting point, superficial parafoveal vessel density (PFSVD) significantly decreased in the SO group (P=0.0403), especially in the superior quadrant or superior-hemi area (P=0.0089, 0.0426, respectively). Parafoveal deep vessel density (PFDVD) had no difference between the two groups. At the second visiting point, all quadrants of PFSVD reduced significantly in the SO group (P=0.0256, 0.0001, 0.0031, <0.0001 in temporal, superior, nasal, and inferior area, respectively), but PFDVD remained no different. In the air group, all areas of PFSVD showed significantly improving from the first visit to the second one (P=0.0324, 0.0001, 0.0371, 0.0026, in temporal, superior, nasal, and inferior area, respectively); however, almost all quadrants of PFDVD showed no changes during this period. In the SO group, both PFSVD and PFDVD showed no obvious changes between the two visiting points. Besides, parafoveal full retinal thickness in the SO group reduced significantly at both visiting points over the air tamponade, while the foveal avascular zone area showed no difference in the two groups. CONCLUSION: After retinal detachment surgery with vitrectomy and SO tamponade, superficial macular perfusion and full retinal thickness could decrease obviously when compared to air tamponade. This reduction process could persist throughout the tamponade period.

14 Evaluation of macular vessel density changes after vitrectomy with silicone oil tamponade in patients with rhegmatogenous retinal detachment

Jian Jiang , Song Chen , Ya-Ding Jia , Rui Li , Jin-Xiu Zhou , Rui-Mei Li

2021, 14(6):881-886. DOI: 10.18240/ijo.2021.06.14

[Abstract](950) [HTML](0) [PDF 1.69 M](607)

Abstract:
AIM: To evaluate macular microvasculature changes in eyes after pars plana vitrectomy (PPV) and intraocular silicone oil (SO) tamponade for macula-off rhegmatogenous retinal detachment (RRD) using optical coherence tomography angiography (OCTA). METHODS: Totally 19 eyes (19 patients) with macula-off RRD who underwent PPV and intraocular SO tamponade were retrospectively reviewed. The parafoveal superficial capillary plexus (SCP) vessel density (VD), deep capillary plexus (DCP) VD, choriocapillaris plexus (CCP) VD, and foveal macular thickness were evaluated using OCTA throughout 16wk postoperatively. The values of healthy fellow eyes were used as control. RESULTS: The parafoveal SCP, DCP, and CCP VDs were significant increased over time in RRD eyes during the 12wk postoperatively, then decreased at 16wk postoperatively (all P<0.01). The ratios of RRD eyes and fellow healthy eyes (r/f ratios) of the SCP and DCP VDs were lower than those of the CCP VD postoperatively (all P<0.05). There were not significant differences in the r/f ratios between SCP and DCP VDs postoperatively (all P>0.05). CONCLUSION: The parafoveal SCP, DCP, and CCP VDs gradually recover over time after PPV surgery with SO tamponade. Long-time SO tamponade might decrease postoperative macular VDs. Compared to parafoveal CCP VD, the parafoveal SCP and DCP VDs were more vulnerable in RRD eyes postoperatively.

15 Awareness and knowledge about glaucoma among patients visiting the screening clinic in Jeddah Eye Hospital, Saudi Arabia

Saleh M. Alqahtani , Marwan A Bakarman , Ahmed Almanjoumi , Sami H. Alzahrani

2021, 14(6):887-895. DOI: 10.18240/ijo.2021.06.15

[Abstract](964) [HTML](0) [PDF 667.90 K](646)

Abstract:
AIM: To explore levels and determinants of awareness and knowledge about glaucoma among patients. METHODS: This was a cross-sectional study that included adult patients from October to the end of December 2018. A semi-structured questionnaire was designed by the researchers to measure the levels of awareness and knowledge about 18 basic information about glaucoma. The sheet was divided into 4 domains: types of glaucoma, risk factors, clinical features, and management. A knowledge score (KS, range=0-18) was calculated, with higher scores indicating higher levels. RESULTS: A total of 383 patients responded to the questionnaire, 61.9% males, mean±SD age was 38.5±12.94 years old, and 61.6% had a university degree or higher. Of them, 6.3% and 23.2% reported personal and family history of glaucoma, respectively. The most frequently reported source of information about glaucoma was another person with glaucoma (28.2%), followed by physicians (24.8%) and TV (19.6%). Knowledge by item ranged from 3.1% to 82.5% correctness rate, while KS showed mean=5.91 and median=5; and reliability testing of the knowledge scale showed Cronbach’s alpha=0.782. Higher KS were found among respondents with higher educational level (P=0.036), diabetes history (P=0.025), and personal (P<0.001) and family (P<0.001) history of glaucoma. CONCLUSION: This study reveals low awareness and knowledge levels about glaucoma among the attendees of a local eye care hospital, where several misconceptions about disease risk factors, clinical features, and management are identified.

16 Association of MTHFR C677T polymorphism with primary open angle glaucoma: a Meta-analysis based on 18 case-control studies

Yu-Mei Yang , Yu-Ping Liu , Dong-Yu Li , Man Yu , Bo Gong , Lin Wang , Ping Shuai

2021, 14(6):896-902. DOI: 10.18240/ijo.2021.06.16

[Abstract](737) [HTML](0) [PDF 2.22 M](708)

Abstract:
AIM: To systematically understand the genetic association between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and primary open angle glaucoma (POAG). METHODS: A comprehensive literature search in Google Scholar, PubMed, Science Citation Index, Foreign Medical Literature Retrieval Service, Chinese National Knowledge Infrastructure and Wanfang Databases was performed to collect all eligible studies up to August 2019. Study selection, data abstraction and study quality evaluation were performed by two independent investigators. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the association. RESULTS: Eighteen case-control studies including 2156 cases and 2201 controls were identified. There was no significant difference in the terms of MTHFR C677T polymorphism and POAG in the Caucasian population (for T vs C OR=1.11, 95%CI: 0.88 to 1.39; for TT vs CC OR=1.01, 95%CI: 0.76 to 1.36; for TT+TC vs CC OR=1.15, 95%CI: 0.84 to 1.58 and for TT vs TC+CC OR=1.02, 95%CI: 0.78 to 1.33). However, a significant effect was revealed in the Asian population (for T vs C OR=1.34, 95%CI: 1.12 to 1.59; for TT+TC vs CC OR=1.41, 95%CI: 1.14 to 1.76). CONCLUSION: Based on 18 eligible studies, we provide a correlation between MTHFR C677T polymorphism and POAG among the Asians subgroup indicating that the T allele or TT +TC genotype may play a critical role in POAG development in Asians.

17 Bibliometric analysis and mapping knowledge domain of pterygium: 2000-2019

Yu-Chi Wang , Fang-Kun Zhao , Qian Liu , Zi-Yan Yu , Jing Wang , Jin-Song Zhang

2021, 14(6):903-914. DOI: 10.18240/ijo.2021.06.17

[Abstract](1302) [HTML](0) [PDF 2.13 M](806)

Abstract:
AIM: To track the knowledge structure, topics in focus, and trends in emerging research in pterygium in the past 20y. METHODS: Base on the Web of Science Core Collection (WoSCC), studies related to pterygium in the past 20y from 2000-2019 have been included. With the help of VOSviewer software, a knowledge map was constructed and the distribution of countries, institutions, journals, and authors in the field of pterygium noted. Meanwhile, using co-citation analysis of references and co-occurrence analysis of keywords, we identified basis and hotspots, thereby obtaining an overview of this field. RESULTS: The search retrieved 1516 publications from WoSCC on pterygium published between 2000 and 2019. In the past two decades, the annual number of publications is on the rise and fluctuated a little. Most productive institutions are from Singapore but the most prolific and active country is the United States. Journal Cornea published the most articles and Coroneo MT contributed the most publications on pterygium. From co-occurrence analysis, the keywords formed 3 clusters: 1) surgical therapeutic techniques and adjuvant of pterygium, 2) occurrence process and pathogenesis of pterygium, and 3) epidemiology, and etiology of pterygium formation. These three clusters were consistent with the clustering in co-citation analysis, in which Cluster 1 contained the most references (74 publications, 47.74%), Cluster 2 contained 53 publications, accounting for 34.19%, and Cluster 3 focused on epidemiology with 18.06% of total 155 co-citation publications. CONCLUSION: This study demonstrates that the research of pterygium is gradually attracting the attention of scholars and researchers. The interaction between authors, institutions, and countries is lack of. Even though, the research hotspot, distribution, and research status in pterygium in this study could provide valuable information for scholars and researchers.

18 Androgen and meibomian gland dysfunction: from basic molecular biology to clinical applications

Li-Xiang Wang , Ying-Ping Deng

2021, 14(6):915-922. DOI: 10.18240/ijo.2021.06.18

[Abstract](1411) [HTML](0) [PDF 609.64 K](1017)

Abstract:
Meibomian gland, the largest sebaceous gland of the body, is responsible for the biosynthesis of lipid layer of the tear film to prevent excessive evaporation. The loss of normal functions of meibomian gland, known as meibomian gland dysfunction (MGD), is a chronic disease and is the leading cause of dry eye symptoms in the clinics. Studies have found sex hormones, especially androgen, play vital roles in the regulation of the functions of meibomian gland. Recently, androgen has also been preliminarily applied in clinics for the treatment of MGD and showed promising results, especially in people with endogenous androgen deficiency. This review summarized the mechanisms of the function of androgen on meibomian gland based on molecular, animal, and clinical studies, and proposed evidence-based views about its potential applications for the treatment of MGD.

19 Commentary review: challenges of intraocular lens implantation for congenital cataract infants

Qi-Hui Zhao , Yun-E Zhao

2021, 14(6):923-930. DOI: 10.18240/ijo.2021.06.19

[Abstract](1094) [HTML](0) [PDF 411.94 K](859)

Abstract:
As an indispensable part of congenital cataract surgery, intraocular lens (IOL) implantation in infantile patients has long-term positive impacts on visual rehabilitation, as well as postoperative complications inevitably. Timing of IOL implantation in infantile congenital cataract patients is not simply a point-in-time but a personalized decision that comprehensively takes age at surgery, risks of postoperative complications, and economic condition of family in consideration, and combines with choosing suitable IOL type and power. For infants with well-developed eyeballs and good systemic conditions, IOL implantation at six months of age or older is safe and effective. Otherwise, secondary IOL implantation may be a safer choice.

20 Intraocular pressure modifications in patients with acute central/hemicentral retinal vein occlusions

Dan Calugaru , Mihai Calugaru

2021, 14(6):931-935. DOI: 10.18240/ijo.2021.06.20

[Abstract](1086) [HTML](0) [PDF 380.85 K](770)

Abstract:
Intraocular pressure (IOP) modifications in patients with acute central/hemicentral retinal vein occlusions (RVOs) consist in IOP reductions and increases. The IOP reduction is due to a transitional hyposecretory phase of the aqueous humor, that increases gradually until 3mo after the venous occlusion onset, and then finally disappears after month 4th. The IOP increases lead to the ocular hypertension and glaucoma. The possible pathogenetic correlations between ocular hypertension/glaucoma and acute central/hemicentral RVOs have been classified into three groups: 1) the venous occlusion precedes the ocular hypertension/glaucoma causing neovascular glaucoma and secondary angle-closure glaucoma without rubeosis; 2) the ocular hypertension and the glaucoma precede the venous occlusion and favor its appearance (ocular hypertension, primary angle-closure, primary angle-closure glaucoma, and open angle glaucomas); and 3) the venous occlusion and the ocular hypertension/glaucoma are mostly age dependent appearances due to common vascular and collagen alterations, lacking a causal connection between the 2 conditions.

21 Primary rhegmatogenous retinal detachment: evaluation of a minimally restricted face-down positioning after pars plana vitrectomy and gas tamponade

Kiichiro Kusaba , Kotaro Tsuboi , Tsuneaki Handa , Yukihiko Shiraki , Takuya Kataoka , Motohiro Kmaei

2021, 14(6):936-939. DOI: 10.18240/ijo.2021.06.21

[Abstract](936) [HTML](0) [PDF 378.47 K](613)

Abstract:
AIM: To evaluate the safety and efficacy of a minimally restricted face-down postoperative positioning following pars plana vitrectomy (PPV) with gas tamponade for primary rhegmatogenous retinal detachment (RRD). METHODS: Patients with primary RRD treated with PPV and gas tamponade and followed up for at least 6mo were selected for the study. All phakic eyes underwent simultaneous cataract surgery. The patients were required to be in a postoperative position that prevented downward flow of retinal tears. Patients with macular detachment were positioned face-down for only a couple of hours. The patients were assessed for preoperative and postoperative best-corrected visual acuity (BCVA), anatomical retinal reattachment rate, and postoperative complications. RESULTS: In total, 40 eyes of 39 patients with primary RRD were included in the study. A single tear was present in 30 eyes (75.0%), multiple retinal tears were present in nine eyes (22.5%), and oral dialysis was present in one eye (2.5%). The anatomical success rate was 90.0% (36 cases) after the primary surgery, and the final anatomical success rate was 100%. The BCVA improved significantly (P<0.001) from 0.75 logarithm angle of resolution (logMAR) preoperatively to 0.12 logMAR at the final visit. Postoperative complications included intraocular pressure elevation (≥25 mm Hg) in 11 patients (27.5%), fibrin formation in two patients (5.0%), pupillary capture of the intraocular lens in two patients (5.0%), and posterior synechia in one patient (2.5%). CONCLUSION: A minimally restricted face-down and flexible postoperative positioning after PPV and gas tamponade for primary RRD is effective and safe.

22 Intravitreally injected ranibizumab versus photodynamic therapy for CNV secondary to choroidal osteoma: a 7-year follow-up case report

Li-Yuan Rong , Li Ran , Shi-Ying Li , Xiao-Hong Meng , Yan-Ling Long , Hai-Wei Xu

2021, 14(6):940-944. DOI: 10.18240/ijo.2021.06.22

[Abstract](877) [HTML](0) [PDF 2.70 M](697)

Abstract:

23 Central retinal artery occlusion and optic neuropathy secondary to platelet rich plasma injection: a case report

Norashikin Maslan , Wan Haslina Wan Abdul Halim , Norshamsiah Md Din , Seng Fai Tang

2021, 14(6):945-947. DOI: 10.18240/ijo.2021.06.23

[Abstract](707) [HTML](0) [PDF 1.64 M](627)

Abstract:

24 Central retinal artery occlusion in eosinophilic granulomatosis with polyangiitis (Churg-Strauss Syndrome): the first case report in South Korea

Jungyul Park , Up Huh , Hee-young Choi , Seunggeun Lee , Miyeun Han , Sungwoon Chung , Hyerim Kim

2021, 14(6):948-951. DOI: 10.18240/ijo.2021.06.24

[Abstract](745) [HTML](0) [PDF 930.80 K](575)

Abstract:

25 Ophthalmic characteristics of carotid cavernous fistula: a case report

Li Yang , Qing-Qing Tan , Chang-Jun Lan , Xuan Liao

2021, 14(6):952-954. DOI: 10.18240/ijo.2021.06.25

[Abstract](737) [HTML](0) [PDF 492.82 K](619)

Abstract:

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Volume 14,Issue 6,2021 Table of Contents