Volume 15,Issue 5,2022 Table of Contents

1 Hyperosmolarity disrupts tight junction via TNF-α/MMP pathway in primary human corneal epithelial cells

Yun Zhang , Ming Yang , Shi-Xin Zhao , Li Nie , Li-Jun Shen , Wei Han

2022, 15(5):683-689. DOI: 10.18240/ijo.2022.05.01

[Abstract](654) [HTML](0) [PDF 2.47 M](696)

Abstract:
AIM: To investigate the mechanism of the tight junction (TJ) disruption and the association between tumor necrosis factor (TNF)-α and matrix metalloproteinase (MMPs) under hyperosmotic condition in primary human corneal epithelial cells (HCECs). METHODS: The cultured HCECs were exposed to media which adding sodium chloride (NaCl) for hyperosmolar stress or adding rh-TNF-α (10 ng/mL). NF-κB inhibitor (5 μmol/L) or GM-6001 (potent and broad spectrum MMP inhibitor, 20 μmol/L) was added 1h before that treatment. The integrity of TJ proteins was determined by immunofluorescent (IF) staining. The mRNA levels of TNF-α and MMPs were evaluated by quantitative reverse transcription polymerase chain reaction (RT-qPCR) and the protein expression by enzyme-linked immunosorbent assay (ELISA). RESULTS: TJ proteins ZO-1 and Occludin were disrupted in primary HCECs exposed to hyperosmotic medium. The mRNA expression and protein production of TNF-α increased significantly in hyperosmotic media at 500 mOsM. TNF-α mediated the expression and production of MMP-1, MMP-13, MMP-9, and MMP-3 stimulated by hyperosmotic stress. The production of MMPs in hyperosmolar media were increased through the increase of TNF-α. GM-6001 prevent the destruction of ZO-1 and Occludin in hyperosmolar stress and rh-TNF-α treated medium. TNF-α induced activation of MMPs was involved in the TJ disruption by hyperosmolarity. CONCLUSION: TJ proteins ZO-1 and Occludin are disrupted by hyperosmolar stress and TNF-α, but protected by MMP inhibitor (GM-6001). It suggests that TNF-α/MMP pathway mediates the TJ disruption in primary HCECs exposed to hyperosmotic stress.

2 Exosome-mediated aptamer S58 reduces fibrosis in a rat glaucoma filtration surgery model

Qian-Yi Lin , Xiang-Ji Li , Yu Leng , Xiao-Min Zhu , Min Tang , Yi Lin , Wang-Du Luo , Bing-Cai Jiang , Xia Chen , Lin Xie

2022, 15(5):690-700. DOI: 10.18240/ijo.2022.05.02

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AIM: To confirm whether exosome-mediated delivery of aptamer S58 (Exo-S58) has a better antifibrotic effect than naked S58 in human conjunctival fibroblasts (HConFs) and a rat glaucoma filtration surgery (GFS) model. METHODS: To enhance the effective reaction time of aptamer S58 in vivo, we loaded aptamer S58 into exosomes derived from HEK293T cells by PEI transfection to determine the effect of Exo-S58 in HConFs and a rat GFS model. RESULTS: Exo-S58 can significantly reduce cell proliferation, migration and fibrosis in TGF-β2-induced HConFs. In an in vivo experiment, Exo-S58 treatment prolonged filtering bleb retention and reduced fibrosis compared with naked S58 treatment in GFS rats. CONCLUSION: The exosomes are safe and valid carriers to deliver aptamers. Furthermore, Exo-S58 exhibited superior antifibrotic effect than naked S58 both in HConFs cells and rat GFS models.

3 Yes-associated protein promotes endothelial-to-mesenchymal transition of endothelial cells in choroidal neovascularization fibrosis

Rong Zou , Yi-Fan Feng , Ya-Hui Xu , Min-Qian Shen , Xi Zhang , Yuan-Zhi Yuan

2022, 15(5):701-710. DOI: 10.18240/ijo.2022.05.03

[Abstract](1036) [HTML](0) [PDF 2.83 M](839)

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AIM: To reveal whether and how Yes-associated protein (YAP) promotes the occurrence of subretinal fibrosis in age-related macular degeneration (AMD). METHODS: Cobalt chloride (CoCl2) was used in primary human umbilical vein endothelial cells (HUVECs) to induce hypoxia in vitro. Eight-week-old male C57BL/6J mice weighing 19-25 g were used for a choroidal neovascularization (CNV) model induced by laser photocoagulation in vivo. Expression levels of YAP, phosphorylated YAP, mesenchymal markers [α smooth muscle actin (α-SMA), vimentin, and Snail], and endothelial cell markers (CD31 and zonula occludens 1) were measured by Western blotting, quantitative real-time PCR, and immunofluorescence microscopy. Small molecules YC-1 (Lificiguat, a specific inhibitor of hypoxia-inducible factor 1α), CA3 (CIL56, an inhibitor of YAP), and XMU-MP-1 (an inhibitor of Hippo kinase MST1/2, which activates YAP) were used to explore the underlying mechanism. RESULTS: CoCl2 increased expression of mesenchymal markers, decreased expression of endothelial cell markers, and enhanced the ability of primary HUVECs to proliferate and migrate. YC-1 suppressed hypoxia-induced endothelial-to-mesenchymal transition (EndMT). Moreover, hypoxia promoted total expression, inhibited phosphorylation, and enhanced the transcriptional activity of YAP. XMU-MP-1 enhanced hypoxia-induced EndMT, whereas CA3 elicited the opposite effect. Expression of YAP, α-SMA, and vimentin were upregulated in the laser-induced CNV model. However, silencing of YAP by vitreous injection of small interfering RNA targeting YAP could reverse these changes. CONCLUSION: The findings reveal a critical role of the hypoxia-inducible factor-1α (HIF-1α)/YAP signaling axis in EndMT and provide a new therapeutic target for treatment of subretinal fibrosis in AMD.

4 Chordin-like 2 influences the differentiation fate of retinal pigment epithelium cells by dynamically regulating BMP pathway

Duo Li , Song-Tao Yuan , Xin-Yi Xie , Han Shen , Qing-Huai Liu , Yong Yao

2022, 15(5):711-720. DOI: 10.18240/ijo.2022.05.04

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AIM: To explore the functions of Chordin-like 2, which is encoded by CHRDL2, in the process of retinal pigmented epithelium (RPE) differentiation and damage repair. METHODS: The fetal RPE cells (fRPE) was obtained from aborted fetus which obeyed medical ethics. Real-time quantitative polymerase chain reaction was used to measure expression quantity of CHRDL2 and other functional genes expression. Knocking down and overexpression was used to analyze the functions about Chordin-like 2. Enzyme-linked immunosorbent assay (ELISA) was used to detect the secretion of bone morphogenetic proteins 4 (BMP4). Flow cytometry was used to analyze cell cycle. Cell morphology was observed by phase contrast microscope (PCM). RESULTS: In normal RPE cells, CHRDL2 was firstly upregulated and followed a downregulation but eventually, it was expressed higher than the cells which undergone epithelial-mesenchymal transition (EMT). After knocking down CHRDL2, the secretion of BMP4 was decreased, RPE-related genes (OTX2, MITF, RPE65) were downregulated while EMT-related genes (SNAI1, VIM) were upregulated. However, the expression of these related genes after overexpression of CHRDL2 had contrary results. Chordin-like 2 also regulated the cell cycle by regulating BMP pathway. When CHRDL2 was knocked down, more fRPE cells stayed in S phase of cell cycle, while adding BMP4 reduced the proportion of the cells in S phase. However, overexpression of CHRDL2 increased more BMP4 secretion, this effect decreased the number of cells in S phase, but exogenous BMP inhibitor also could change this effect. At last, in the process of RPE cells differentiation, adding BMP4 at early stage could intervene normal RPE differentiation. Compared with BMP4, inhibiting BMP pathway had no significant negative effect at early stage, but suppressed differentiation at late stage. CONCLUSION: BMP pathway can be activated in a correct temporal order, otherwise, the cells have incorrect differentiation orientation. And Chordin-like 2 plays a role in dynamic regulation of BMP pathway and it also regulates the differentiation of RPE cells. Therefore, this research enlightens a new direction to inhibit EMT and promote cell redifferentiation after injury.

5 Topography versus non-topography-guided photorefractive keratectomy with corneal cross-linking variations in keratoconus

Sana Niazi , Jorge Alio del Barrio , Azad Sanginabadi , Farideh Doroodgar , Cyrus Alinia , Alireza Baradaran-Rafii , Feaizollah Niazi , Hossein Mohammad-Rabei , Mohammad Mehdi Sadoughi , Jorge L. Alio

2022, 15(5):721-727. DOI: 10.18240/ijo.2022.05.05

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AIM: To compare the visual results of non-topography-guided and topography-guided photorefractive keratectomy (PRK) applying sequential and simultaneous corneal cross-linking (CXL) treatment for keratoconus. METHODS: Interventional and comparative prospective study. Sixty-nine eyes (36 patients) suffering from keratoconus (stages 1 Amsler-Krumeich classification) were divided into four groups: sequential topography-guided photorefractive keratectomy with CXL, simultaneous topography-guided photorefractive keratectomy with CXL, simultaneous non-topography guided photorefractive keratectomy with CXL, and sequential non-topography guided photorefractive keratectomy with CXL. The main outcome measures were pre- and postoperative uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (CDVA), manifest refraction, contrast sensitivity, and keratometry. RESULTS: All analyzed visual, contrast sensitivity, and refractive parameters showed a significant improvement in the four groups (all P<0.05). A noticeable improvement was seen in keratometry in all the groups, and a remarkable difference was observed between topography-guided groups in comparison to non-topography-guided groups (P<0.05). Interestingly, the improvement in all parameters showed a degree of stability to the end of the follow-up. CONCLUSION: The treatment priorities in all four groups are safety, efficacy, and predictability in the correction of the sphero-cylindrical errors in mild and moderate keratoconus. No significant differences among groups in the recorded objective outcomes were found.

6 A novel analysis of Scheimpflug total corneal refractive power following corneal cross-linking in mild to moderate keratoconus

Chao Pan , Wei-Na Tan , Dan Chen , Yu Liu , Hao-Yu Wang , Deng-Feng Liang , Yan-Jun Hua , Xiao-Hua Lei , Qing-Yan Zeng , Shao-Zhen Zhao

2022, 15(5):728-735. DOI: 10.18240/ijo.2022.05.06

[Abstract](443) [HTML](0) [PDF 1.20 M](554)

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AIM: To detect an earlier improvement in mild to moderate keratoconus following corneal cross-linking (CXL) with total corneal refractive power (TCRP) using ray tracing method. METHODS: A total of 40 eyes of 30 consecutive patients who underwent CXL for progressive keratoconus were retrospectively enrolled. The following keratometric parameters provided by Pentacam HR, including maximum keratometry (Kmax), steepest keratometry (Ksteep), 3 mm zonal TCRP centered over corneal apex (TCRPapex,zone 3 mm), zonal mean keratometry and TCRP centered over corneal cone (Kmcone,zone and TCRPcone,zone 1, 2, 3 mm) were evaluated preoperatively and 1, 3, 6, and 12mo postoperatively. Groups 1 and 2 were defined based on Kmax at postoperative 1mo as improved (the initial improvement group) or worsen (the initial deterioration group) compared to the preoperative level. RESULTS: In the overall group, only keratometric parameters based on ray tracing method displayed significant improvement early at 3mo postoperatively, in which TCRPcone,zone 1 mm and 2 mm exhibited the largest flattening (0.57 D and 0.53 D, respectively). In Group 1, only Kmax, Kmcone,zone 2 mm and TCRPcone,zone 2 mm showed significant improvement initially at 1mo postoperatively, in which Kmax exhibited the largest improvement (1.05 D), followed by TCRPcone,zone 2 mm (0.82 D). In Group 2, only keratometric parameters based on ray tracing method and Kmcone,zone 3 mm showed slight but not significant improvement early at 3mo, in which TCRPcone,zone 3 mm displayed the most improvement (0.19 D), followed by TCRPcone,zone 2 mm (0.15 D). CONCLUSION: The findings indicate that a 2 mm zonal TCRP centered over Kmax could earlier detect keratometric improvement by CXL compared to other commonly used parameters in mild to moderate keratoconic eyes.

7 Clinical application of a shape-preserving rapid corneal donor dehydrater

Yu Sun , Xiao-Lin Qi , Xiao Lin , Xiao-Yu Zhang , Li Gao , Hua Gao

2022, 15(5):736-740. DOI: 10.18240/ijo.2022.05.07

[Abstract](368) [HTML](0) [PDF 882.91 K](530)

Abstract:
AIM: To describe the design and clinical application of a corneal donor dehydrator which can quickly dehydrate corneas and keep its original shape. METHODS: The corneal donor material is placed on stainless steel beads with different diameters in the dehydrating box to make the cornea the same shape as the steel ball. Then, the cornea is placed inside the dehydrater for rapid dehydrating using the internal cleaning and ventilation system. Totally 83 eyes underwent deep anterior lamellar keratoplasty (DALK) using corneal donor tissue preserved with corneal dehydrater, and 60 patients (60 eyes) received DALK by the same surgeon using corneal donor tissue preserved with glycerol were included in the control group. The best corrected visual acuity (BCVA), the thickness and transparency of the corneal buttons were recorded. RESULTS: After the completion of dehydrating, all the donor corneas maintained a normal shape without any shrinkage or distortion, and the average intraoperative rehydration time was 43.3±12.1s during operation. The mean BCVA of the dehydrater group was 0.30±0.18 at 1wk and 0.32±0.16 at 1mo, which were statistically better than that of the control group (P<0.001). The score of corneal buttons transparency were lower than that of the control group with statistical difference (P<0.001). The thickness of corneal buttons at 1wk and at 1mo in the dehydrater group was significantly better than that of the control group respectively (P<0.001). One week after operation, no corneal button turbidity or edema was observed in both groups. CONCLUSION: The dehydrater can quickly dehydrate the corneal material in a clean and airtight environment and maintain the original shape of the corneal donor during the dehydrating process. This dehydrater is recommended for long-term high-quality preservation in areas where corneal materials cannot be used within a reasonable time period.

8 Comparison of preoperative simulated and postoperative real safety distances using anterior segment OCT in patients with phakic IOL according to iris configuration

Maria A Henriquez , Maythe Camino-Quezada , Or Ben-Shaul , Luis Izquierdo Jr

2022, 15(5):741-746. DOI: 10.18240/ijo.2022.05.08

[Abstract](455) [HTML](0) [PDF 1.17 M](540)

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AIM: To compare the simulated safe distance (SSD) preoperatively versus real safe distance (RSD) postoperatively in patients with iris-claw phakic intraocular lens (pIOL) implantation according to iris configuration. METHODS: Totally 60 eyes of 60 patients underwent pIOL implantation for surgical correction of myopia. Anterior chamber depth (ACD) was measured with the IOLMaster 700, and nasal and temporal safety distances (SD) were measured pre- and postoperatively using Anterior Segment Visante-OCT. SD was defined as a line measured between the edge of the optic or its simulated image to the endothelium. Eyes were divided into 3 groups: convex, concave, and plane according to preoperatory iris configuration. Statistical analysis was performed using the R program, for the comparison of independent groups and multiple comparisons, the Kruskal-Wallis test and the Dunn test were used respectively. RESULTS: Mean difference between nasal preoperative SSD and postoperative RSD was -0.36±0.38, -0.29±0.48, and -0.18±0.30 mm in the concave, convex, and plane group, respectively. Mean difference between temporal SSD and RSD was -0.36±0.37, -0.14±0.38, and -0.24±0.33 mm in the concave, convex, and plane group, respectively. There were statistically significant differences between SSD and RSS for both nasal and temporal sides in the concave and plane group (P<0.002). CONCLUSION: Preoperative SSD and postoperative RSD for iris-claw pIOL shows significant differences in patients with concave and plane iris.

9 Green tea—a new perspective of glaucoma prevention

Kornelijus Gasiunas , Saulius Galgauskas

2022, 15(5):747-752. DOI: 10.18240/ijo.2022.05.09

[Abstract](612) [HTML](0) [PDF 467.54 K](619)

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AIM: To determine how green tea and catechins can affect intraocular pressure (IOP) changes. METHODS: Totally 43 young volunteers were included in the study. The experiment was held between noon and 2 p.m. Two extracts—green tea and epigallocatechin gallate (EGCG, 400 mg capsules) and placebo (400 mg capsules) were used in the study. Participants were divided into three groups. Green tea extract group (GT group) had 17 subjects, EGCG extract group 17 subjects, control (placebo) group 9 subjects. IOP was measured with the Icare tonometer before and 30min, 1, 1.5, 2h after the consumption of each extract and placebo. Results were analyzed using the IBM SPSS program. Statistical confidence level P<0.05. RESULTS: The most significant reduction of IOP from the beginning of the experiment was measured after 2h in GT group (left 2.18±3.19 mm Hg, P=0.012; right 2.59±1.97 mm Hg, P<0.000) and after 1h in EGCG extract group (left 2.41±2.98 mm Hg, P<0.004; right 1.94±1.98 mm Hg, P<0.001). In control group no significant changes were measured. CONCLUSION: People who have increased IOP or risk factors for glaucoma development, could benefit from drinking green tea or its concentrated extracts in moderate doses.

10 Efficacy evaluation of intravitreal ranibizumab therapy for three types of retinopathy of prematurity

Qiong Zou , Yan-Qiong Zhu , Feng-Jun Zhang , Qiu-Ping Liu

2022, 15(5):753-759. DOI: 10.18240/ijo.2022.05.10

[Abstract](443) [HTML](0) [PDF 610.90 K](610)

Abstract:
AIM: To evaluate efficacy of intravitreal ranibizumab (IVR) therapy for aggressive posterior retinopathy of prematurity (ROP), threshold ROP disease and type 1 pre-threshold ROP. METHODS: A retrospective analysis was performed on 40 patients (76 eyes) who had IVR as the primary treatment for ROP from April 2017 to January 2018. According to disease pathogenic features, the 76 eyes were divided into three groups: aggressive posterior ROP (AP-ROP) group (16 eyes), threshold ROP group (28 eyes) and type 1 pre-threshold ROP group (32 eyes). The characteristics of patients and lesions situation before the first intravitreal injection, and posttreatment fundus outcomes determined by wide-angle RetCam fundus imaging were recorded. RESULTS: The birth weight and postmenstrual age of first IVR treatment in AP-ROP, threshold ROP, and type 1 pre-threshold ROP groups were significant difference (1087.50±246.78, 1103.75±168.30, 1257.03±210.82 g, P=0.005; 34.50±1.46, 36.89±2.97, 36.50±2.36wk, P=0.008), while the gestational age was not difference (28.00±2.00, 28.54±1.90, 28.59±1.43wk, P=0.510). The retina hemorrhage ratio (with/without: 14/2, 8/20, 5/27), iris neovascularization or vascular engorgement ratio (with/without: 12/4, 11/17, 6/26), and the zone I (inside/outside: 16/0, 2/26, 5/27) in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group were difference significantly (all P<0.05). The regression rates were 37.5%, 92.86%, and 100%, and the recurrence rates were 62.5%, 7.14%, and 0 in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group, respectively (both P<0.05). The recurrence eyes were cured by secondary IVR or retinal laser photocoagulation. CONCLUSION: IVR is an effective treatment for all types of ROP. The regression of AP-ROP is significantly lower than type 1 pre-threshold and threshold disease. Birth weight, retinal hemorrhage, iris neovascularization or vascular engorgement and lesions located in zone I may be associated with AP-ROP recurrence and retreatment, which should be noted in follow-up.

11 Amniotic membrane for covering high myopic macular hole associated with retinal detachment following failed primary surgery

Gang Qiao , Xiao-Juan Zhang , Zi-Yan Tang , Qiang-Xing Zou , Chun-Mei He , Xian-Ming Lei , Long Zhao , Yu Quan , Hua-Qing Yang , Kui Cao , Wan-Jiang Dong

2022, 15(5):760-765. DOI: 10.18240/ijo.2022.05.11

[Abstract](571) [HTML](0) [PDF 919.19 K](642)

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AIM: To evaluate the therapeutic effect of amniotic membrane (AM) for covering high myopic macular hole associated with retinal detachment following failed primary surgery. METHODS: Seventeen eyes of 17 patients whose axial length was more than 29 mm suffered from macular hole (MH) or MH associated with retinal detachment (RD), and had previously surgery of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and silicone oil (SO) tamponade. Half a year after the surgery, optical coherence tomography (OCT) showed that MH did not heal in all 17 eyes and RD was still maintained in 13 eyes of these 17 eyes. We performed SO removal combined with AM covering on macular area and C3F8 tamponade, and phacoemulsification combined with intraocular lens implantation simultaneously cataract eyes. We followed up these patients for one year. RESULTS: In all 17 eyes, SO was removed successfully, MHs were healed and RDs were reattached. One eye (5.89%, 1/17) had AM shifted half a month after surgery and underwent a second surgery to adjust the position of the AM and supplement C3F8. After surgery, the visual acuity (VA) improved in 15 eyes (88.24%, 15/17), no change in two eyes (11.76%, 2/17). No serious complications occurred in all eyes. CONCLUSION: AM covering is helpful to rescue the previous failure surgery of high myopic MH.

12 Prophylactic juxtapapillary laser photocoagulation in pediatric morning glory syndrome

Yi-Hua Zou , Kai-Qin She , Jia-Ning Ren , Ting-Yi Liang , Ping Fei , Yu Xu , Jing Li , Xiang Zhang , Jie Peng , Pei-Quan Zhao

2022, 15(5):766-772. DOI: 10.18240/ijo.2022.05.12

[Abstract](585) [HTML](0) [PDF 1.13 M](633)

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AIM: To determine the anatomic and visual outcomes of prophylactic juxtapapillary laser photocoagulation treatment alone in the prevention of retinal detachment (RD) in a cohort of pediatric patients diagnosed with morning glory syndrome (MGS). METHODS: A total of 24 eyes of 22 consecutive patients aged 0-15y diagnosed with MGS treated with prophylactic juxtapapillary laser photocoagulation alone were reviewed. Data including demographics, ocular examination, anatomic and visual outcomes, following treatment and complications were collected. RESULTS: Two patients had bilateral laser treatment and 20 had monocular laser treatment. The age at treatment of 13 (59.1%) patients was less than 12mo. The presenting symptoms included strabismus (6/22, 27.3%), decreased vision (2/22, 9.1%), and routine fundus screening (14/22, 63.6%). Fifteen (68.2%) patients underwent cranial magnetic resonance imaging (MRI) examinations, and 3 of those 15 (20.0%) had abnormal findings in the nervous system. Based on preoperative wide-field fundus photography and B-scan echography, all (100.0%) eyes had no obvious RD. On postoperative 1mo and 6mo and the following follow-ups, the anatomic outcomes of all eyes remained stable. The mean follow-up duration was 27.7±17.5mo. No severe complications were found. Preoperative visual acuity acquired from 2 (9.1%) patients ranged from light perception to 20/200. Postoperative acuity acquired from 11 (50.0%) patients ranged from light perception to 20/125. CONCLUSION: The preliminary anatomic and visual outcomes of prophylactic juxtapapillary laser treatment alone in pediatric MGS patients are relatively stable in a short-term follow-up. Further long-term clinical observation will be needed to confirm its efficacy and safety.

13 Neuroretinal dysfunction in patients affected by neurofibromatosis type 1

Antonietta Moramarco , Luca Lucchino , Fabiana Mallone , Michela Marcelli , Ludovico Alisi , Vincenzo Roberti , Sandra Giustini , Alessandro Lambiase , Marcella Nebbioso

2022, 15(5):773-779. DOI: 10.18240/ijo.2022.05.13

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AIM: To examine neuroretinal function by using the multifocal electroretinography (mfERG) test in patients with neurofibromatosis type 1 (NF1) without optic pathway gliomas (OPGs). METHODS: This study was conducted on 35 patients (35 eyes) with NF1 and 30 healthy subjects (30 eyes) for the control group. Each subject underwent a complete ophthalmological examination including spectral domain-optical coherence tomography (SD-OCT) and mfERG. The 1.5-Tesla magnetic resonance imaging (MRI) scan of the brain was performed in NF1 patients to assess the presence of OPGs. All participants were recruited having a best corrected visual acuity (BCVA) of no less than 20/20 in each eye. The amplitude and implicit time of the P1 wave (first-order Kernel component) were evaluated on mfERG. Data analysis was carried out in the two central degrees and in the four quadrants from two to 25 degrees of visual field. RESULTS: Statistically significant results were obtained for the P1 wave amplitudes in the 4 quadrants in NF1 patients compared to healthy controls, while the reduction was not significant in the 2 central degrees between the groups. A statistically significant difference was observed among the P1 wave amplitudes as recorded in the 4 quadrants within the NF1 group, with lower amplitudes detected in the nasal quadrants. No differences in the implicit times were recorded in the 2 central degrees and in the 4 quadrants as compared between NF1 patients and controls. CONCLUSION: Impaired neuroretinal function in NF1 patients is expressed in a decreased amplitude of the P1-wave between 2 and 25 central retinal degrees on mfERG. Altered intracellular signal transduction due to abnormal neurofibromin-mediated cyclic adenosine monophosphate (cAMP) generation, can be involved. The possible use of mfERG as subclinical retinal damage indicator has a potential utility in clinical practice for the follow-up of NF1 patients.

14 Comparison of clinical outcome of small-incision lenticule intrastromal keratoplasty and FS-LASIK for correction of moderate and high hyperopia

Li Zhang , Yue-Hua Zhou , Chang-Bin Zhai , Jing Zhang , Yan Zheng

2022, 15(5):780-785. DOI: 10.18240/ijo.2022.05.14

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Abstract:
AIM: To compare the clinical outcome of small-incision lenticule intrastromal keratoplasty (sLIKE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for correction of moderate and high hyperopia. METHODS: A case-controlled clinical study was performed. Twenty right eyes of 20 moderate and high hyperopia patients underwent sLIKE (sLIKE group) and 22 right eyes of 22 moderate and high hyperopia patients underwent FS-LASIK (FS-LASIK group) were enrolled in this study from October 2015 to October 2017. Visual acuity, refractive error, corneal thickness, and keratometry were compared between the groups before and 1y postoperatively. RESULTS: The postoperative uncorrected near visual acuity (UNVA) and uncorrected distance visual acuity (UDVA) were improved in the two groups. The UNVA reached J1 in 15 eyes (75.0%) in the sLIKE group and 5 eyes (22.7%) in the FS-LASIK group 1y after surgery (χ2=11.476, P=0.001). The UDVA was equal or better than the preoperative CDVA in 16 eyes (80.0%) in the sLIKE group and 8 eyes (36.4%) in the FS-LASIK group, respectively (X2=8.145, P=0.004). No eyes lost any line of best-corrected visual acuity (BCVA) in either group. The amount of postoperative residual hyperopia in the sLIKE group was significantly less than in the FS-LASIK group (Z=-2.841, P=0.004). The postoperative keratometry and corneal thickness were significantly higher in the sLIKE group than in the FS-LASIK group (t=4.411, 10.279, P<0.001). The SRI and SAI of the sLIKE group were significantly higher than that in the FS-LASIK group. There was no statistically significant difference in mean decentration between the two groups. CONCLUSION: sLIKE has better visual and refractive outcome than FS-LASIK for correction of moderate and high hyperopia.

15 Factors affecting single-step transepithelial photorefractive keratectomy outcome in the treatment of mild, moderate, and high myopia: a cohort study

Mansour M. Al-Mohaimeed

2022, 15(5):786-792. DOI: 10.18240/ijo.2022.05.15

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Abstract:
AIM: To investigate the effect of preoperative factors on visual acuity, higher-order aberrations (HOAs), and index of success for spherical change (S.IOS) after transepithelial photorefractive keratectomy (t-PRK) for treating different grades of myopia. METHODS: This was a retrospective one-armed cohort study where patients with high, moderate, or mild myopia treated with single-step t-PRK using Amaris 500 Hz excimer laser were evaluated for visual acuity, refractive status, corneal topography, HOAs, S.IOS, and mean efficiency and safety index before and 6mo after surgery. RESULTS: A total of 154 eyes of 77 patients with mild (n=59), moderate (n=83), and high (n=12) myopia were reviewed. The efficiency and safety indices for vision recovery by single-step t-PRK were 98% and 100%, respectively. The achieved spherical equivalent (SE) was within 1 diopter (D) in 151 (98%) eyes. The median of the S.IOS was 1.18 [interquartile range (IQR) 1.0, 1.4]. The change in S.IOS was significantly correlated with age (P=0.007), 6.5 mm ablation zone (Mann-Whitney U test, P<0.01), and mild and moderate grade of myopia (Kruskal–Wallis test, P<0.001). Trefoil aberration, spherical aberration, and aberration coefficient types of HOA increased significantly (Wilcoxon test, P<0.001) 6mo post-surgery. There was a significant correlation between spherical aberration and aberration coefficient HOAs by myopia grades (P<0.05). CONCLUSION: Single-step t-PRK has promising short-term outcomes for refractive corrections and vision improvement to treat all three grades of myopia.

16 Accuracy of segmented measurement of axial length in ultra-high myopia filled with silicone oil using immersion B-scan ultrasonography

Qing-Hua Yang , Hong-Tao Zhang , Xiao-Qi Li , Bing Chen , Zhao-Hui Li , Yi-Fei Huang , Xin Jin , Ying Zhang , Li-Qiang Wang

2022, 15(5):793-799. DOI: 10.18240/ijo.2022.05.16

[Abstract](496) [HTML](0) [PDF 564.21 K](587)

Abstract:
AIM: To evaluate the accuracy of segmented measurement of axial length (AL) in high myopia filled with silicone oil by immersion B-scan ultrasonography (immersion B-scan). METHODS: From June 2016 to June 2020, a total of 67 ultra-high myopia inpatients (67 eyes) who underwent silicone oil removal combined with cataract extraction and intraocular lens (IOL) implantation were retrospectively enrolled. The preoperative axial length (AL) of 31 patients with severe cataract were segmented measured using immersion B-scan (B-scan group) and another 36 patients with mild or moderate cataract were measured using IOLMaster 500 (IOLMaster group). The post-operative ALs in two groups were both measured using IOLMaster 500. The IOL power was calculated with Haigis formula. The differences in ALs between pre- and post-surgery, as well as the postoperative refractive spherical equivalent, absolute refractive error, the prediction deviation of postoperative refraction and best corrected visual acuity (BCVA) were compared. RESULTS: The pre- and post-operative ALs were 30.46±1.63 mm (range 28.09-33.51 mm) and 30.42±1.70 mm (range 28.03-33.90 mm) in B-scan group (t=0.644, P=0.542) and 30.51±1.21 mm (range 28.03-33.90 mm) and 30.43±1.27mm (range 28.54-33.50 mm) in IOLMaster group (t=1.843, P=0.074), respectively. Three months after surgery, BCVA were 0.45±0.13 (range 0.3-0.9) and 0.44±0.20 (range 0.2-1.0) in B-scan and IOLMaster group respectively (t=0.086, P=0.932). There was no significant difference of the postoperative spherical equivalent (-3.11±0.65 D vs -3.21±0.51 D, t=0.671, P=0.505) and the absolute refractive error (0.589±0.340 vs 0.470±0.245 D, t=1.615, P=0.112) between two groups. In B-scan group, absolute refractive error within ±0.50 D was found in 18 eyes (58.1%), within ±1.00 D in 26 eyes (83.9%), and within ±1.50 D in 31 eyes (100%). In IOLMaster group, absolute refractive error within ±0.50 D was found in 23 eyes (63.9%), within ±1.00 D in 34 eyes (94.4%), and within ±1.50 D in 36 eyes (Z=0.757, P=0.449). CONCLUSION: The segmented measurement of ALs by immersion B-scan shows comparable measurement accuracy with that of IOLMaster 500 in ultra-high myopia patients with severe cataract secondary to silicone oil filling and can obtain an ideal postoperative refractive state.

17 A randomized study of network-based perception learning in the treatment of amblyopia children

Chang-Yue Zheng , Wei Xu , Shun-Qiang Wu , Dong-Xu Han

2022, 15(5):800-806. DOI: 10.18240/ijo.2022.05.17

[Abstract](470) [HTML](0) [PDF 1.14 M](621)

Abstract:
AIM: To compare the effectiveness of network-based perception learning (NBPL) and traditional training in the treatment of amblyopia children. METHODS: This randomized controlled clinical trial recruited 56 participants aged 4-12y with anisometropic and/or strabismic amblyopia. Participants were randomly divided into two groups: the NBPL group (n=28) who received patching and NBPL for 3mo, and the control group (n=28) who got 3mo of patching and traditional training. Best-corrected visual acuity (BCVA) in the amblyopic eye and stereoacuity were measured and compared at baseline, 1, 2, and 3mo post-randomization. RESULTS: There were no significant differences in age, gender ratio, and BCVA between the two groups at baseline. At 3mo, most patients gained lines (2 logMAR lines on average) of BCVA in both groups except one 11-year-old girl in the control group (P<0.05). But no significant difference in BCVA improvement of the amblyopic eye between the two groups was found (P=0.725), and amblyopia resolved (BCVA of 0.1 logMAR or better or within 1 logMAR line of the fellow eye) for 13 (46.4%) participants in both groups. The number of patients with improvement of stereoacuity was 25 and 13 in the NBPL group and control group (P=0.041), respectively, and a significant difference exists in the distribution of stereopsis at 3mo between the two groups (P=0.015). Besides, in patients with measurable stereopsis improvement degree and space for improvement in the two groups, the NBPL group also achieved better stereoscopic improvement than the control group (10/11 vs 4/11, P<0.05). CONCLUSION: The NBPL system has a significant effect on the improvement of BCVA and stereoacuity of amblyopia children and is better than traditional training in terms of stereoacuity improvement. Perceptual learning visual training may play a more important role in the treatment of amblyopia in the future.

18 Prevalence and inconformity of refractive errors and ocular biometry of 3573 medical university freshman students for 4 consecutive years

Hui-Juan Gao , Hong-Mei Zhang , Wei-Yu Dang , Lin Liu , Yun Zhu , Qing He , Xin Wang , Yan-Hui Chen , Fei Gao , Qing-Xin Wang , Hua Rong , Shu-Ling Niu , Rui-Hua Wei

2022, 15(5):807-812. DOI: 10.18240/ijo.2022.05.18

[Abstract](665) [HTML](0) [PDF 412.20 K](609)

Abstract:
AIM: To evaluate the prevalence of refractive errors and ocular biometry in 3573 freshman students at Tianjin Medical University for 4 consecutive years. METHODS: In this university-based, cross-sectional study, comprising 3573 students, visual acuity (VA), slit-lamp examination, non-cycloplegic auto-refraction, and ocular biometry were recorded. RESULTS: The prevalence of myopia increased annually, from 2017 to 2020 were 93.5%, 94.5%, 95.9%, and 96.2%, respectively (P=0.03), and the prevalence of high myopia was 25.7%, 26.9%, 28.6%, and 28.6%, respectively. Males tended to have a higher percentage of total astigmatism than females, with astigmatism ≥0.75 and ≥1.0 D criteria. The percentage of with-the-rule astigmatism, against-the-rule astigmatism, and oblique astigmatism was 90.3%, 5.8%, and 3.9%, respectively, with astigmatism ≥1.00 D criteria. The mean spherical equivalent, axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), corneal radius (CR), and lens position (LP) were 4.37±2.52 D, 25.28±1.24 mm, 539.49±34.98 μm, 3.31±0.34 mm, 3.47±0.21 mm, 7.8±0.28 mm, and 5.04±0.32 mm, respectively. With diopter increase in myopia, the AL became longer, CR became steeper, ACD became deeper, LT became thinner, and LP became more posterior (all P<0.01). Females had a shorter AL, thinner CCT, smaller CR, shallower ACD, thicker lens, and more anterior LP than males (P<0.01). The 64% of high myopia had AL≥26 mm, meanwhile, 5.8% mild myopia and 21.1% moderate myopia had AL≥26 mm. With AL≥26 mm, mild and moderate myopia compared to high myopia, AL was shorter (26.51±0.46 vs 26.87±0.70 mm), CR was larger (8.10±0.3 vs 7.85±0.23 mm) and LT was thinner (3.39±0.19 vs 3.45±0.19 mm, P<0.001). CONCLUSION: The prevalence of myopia and high myopia is significantly high in freshman students. The majority of astigmatism is with-the-rule. Inconformity of refractive errors and ocular biometry existed in some students. Attention should be paid to the ocular biometry of myopia.

19 Effects of anti-TNF biologic drugs on uveitis severity in Behçet patients: systematic review and Meta-analysis

Somayeh Abolhasani , Alireza Khabbazi , Foroogh Hosseini , Shiva Gholizadeh-Ghaleh Aziz , Shahriar Alipour

2022, 15(5):813-819. DOI: 10.18240/ijo.2022.05.19

[Abstract](505) [HTML](0) [PDF 793.45 K](587)

Abstract:
AIM: To investigate effects of anti-TNF biologic drugs on uveitis severity (comparing visual acuity logMAR levels) in Behçet patients. METHODS: Three databases PubMed, Scopus, and the Web of Science were searched for qualified papers focusing on the anti-TNF-α factors treatment in Behçet’s disease (BD)-associated uveitis. Studies that were designed pre and post anti-TNF drug treatment, were selected. After determining the search strategy for this study, the relevant data were extracted. RESULTS: The initial search was performed in the target databases and a total of about 1458 articles were found. Fifteen articles were selected for systematic review and only 12 of them had inclusion criteria for Meta-analysis (with visual acuity data). The mean dose of prednisolone before and after biological treatments was reported in 5 studies (28.56 and 7.56 mg/kg, respectively). Also, the preliminary results indicate a significant reduction in visual acuity logMAR levels (MD=-1.5 IU/L, 95%CI: -2.1, -0.01). CONCLUSION: Biological drugs significantly reduce the dose of prednisolone and affect visual acuity values.

20 Inflammation and dry eye disease—where are we?

Srinivas K Rao , Rishi Mohan , Nikhil Gokhale , Himanshu Matalia , Paras Mehta

2022, 15(5):820-827. DOI: 10.18240/ijo.2022.05.20

[Abstract](980) [HTML](0) [PDF 845.30 K](893)

Abstract:
The presence of inflammation in dry eye disease (DED) results in increased patient symptomatology, ocular surface damage and worsening tear dysfunction. It also affects the health of meibomian glands and their secretions which further aggravates ocular surface disease. This article reviews current knowledge regarding ocular surface inflammation in DED and explores the relationships between the vicious cycles of DED, inflammation and meibomian gland dysfunction (MGD). The clinical evaluation of eyes with such changes, markers that identify the presence of inflammation on the ocular surface and current treatment options are discussed.

21 Genetic, environmental and other risk factors for progression of retinitis pigmentosa

Zi-Yang Huang , Li-Na Liang , Ya-Min Li , Kai Xu , Xiao-Yu Li

2022, 15(5):828-837. DOI: 10.18240/ijo.2022.05.21

[Abstract](801) [HTML](0) [PDF 385.70 K](691)

Abstract:
Retinitis pigmentosa (RP) is a commonly inherited disease of the retina, which is characterized by progressive loss of visual function due to specific genetic mutations. There are many risk factors that may have effect on the progression of RP, such as inheritance patterns, genotype, gender, age, smoking, physical activity, and other demographic and environmental factors. Baseline visual field conditions, changes of ellipsoid zone, photoreceptor layer thickness, and choroidal structure are reported to be the phenotype risk factors for RP progression. Moreover, aqueous flare and high-sensitivity C-reactive protein are probable inflammation biomarkers for assessing the progression of RP. Increased oxidative stress is considered to be one of the potential factors for the existence of RP. The risk factors can be combined to form a corresponding prediction model to predict disease progression. This review is to summarize the current literature that studies the genetic, environmental, phenotypic, demographic, inflammatory and other risk factors of RP progression and discuss the most reliable risk factors that could provide predictive models.

22 Persistent macular oedema following Best vitelliform macular dystrophy undergoing anti-VEGF treatment

Tie-Zhu Lin , Emmanuel Eric Pazo , Yue Ren , Li-Jun Shen

2022, 15(5):838-840. DOI: 10.18240/ijo.2022.05.22

[Abstract](320) [HTML](0) [PDF 955.98 K](540)

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23 Can a sneeze after phacoemulsification cause endophthalmitis? A case report

Yi-Wen Qian , Qing-Jian Li , Xin Che , Jing Jiang , Zhi-Liang Wang

2022, 15(5):841-844. DOI: 10.18240/ijo.2022.05.23

[Abstract](413) [HTML](0) [PDF 1.35 M](561)

Abstract:

24 Multimodal imaging in Purtscher-like retinopathy associated with sarcoidosis: a case report

Héla Kaoual , Inés Hachicha , Ilhem Mili Boussen , Imène Zhioua-Braham , Mejdi Boukari , Raja Zhioua

2022, 15(5):845-847. DOI: 10.18240/ijo.2022.05.24

[Abstract](310) [HTML](0) [PDF 1.45 M](534)

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25 Periorbital necrotizing fasciitis accompanied by sinusitis and intracranial epidural abscess in an immunocompetent patient

Su Youn Suh , Jung Hyo Ahn

2022, 15(5):848-850. DOI: 10.18240/ijo.2022.05.25

[Abstract](288) [HTML](0) [PDF 548.01 K](502)

Abstract:

26 Multimodal imaging in immunogammopathy maculopathy secondary to Waldenstrom’s macroglobulinemia: a case report

Hui-Rong Xu , Jie Zhu , Xiao-Yan Xie , Jun Zhu , Fang Chen

2022, 15(5):851-854. DOI: 10.18240/ijo.2022.05.26

[Abstract](391) [HTML](0) [PDF 1.12 M](535)

Abstract:

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Volume 15,Issue 5,2022 Table of Contents