Volume 15,Issue 9,2022 Table of Contents

1 What can we learn from negative results in clinical trials for proliferative vitreoretinopathy?

Peter Wiedemann

2022, 15(9):1413-1415. DOI: 10.18240/ijo.2022.09.01

[Abstract](366) [HTML](0) [PDF 276.82 K](463)

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2 Corneal histomorphology and electron microscopic observation of R124L mutated corneal dystrophy in a relapsed pedigree

Meng-Jun Fu , Jing Zhao , Shan Duan , Hao-Run Zhang , Jing-Jing Zhao , Li Zeng , Rui Wang , Xing-Tao Zhou

2022, 15(9):1416-1422. DOI: 10.18240/ijo.2022.09.02

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AIM: To investigate the histological characteristics and ultrastructure of recurrent Chinese R124L mutated corneal dystrophy after keratoplasty. METHODS: The subjects were enrolled from a Chinese family of corneal dystrophy with R124L heterozygous gene mutation and with a history of consanguineous marriage. Normal corneal samples were used as controls. RESULTS: In this family, 2 patients (3 eyes) underwent penetrating keratoplasty (PKP) and 2 patients (4 eyes) underwent lamellar keratoplasty (LKP). They had recurrence at 33.5±3.0 (range 30-36)mo after keratoplasty. Among them, 1 patient (1 eye) underwent PKP again and 1 patient (2 eyes) underwent LKP again. In the R124L mutated recurrent corneal dystrophy, the corneal turbidity was mainly distributed from the upper corneal cortex to the anterior stroma; the corneal epithelium surface was rougher and more uneven; and, the corneal erosions were larger. Hematoxylin-eosin staining showed that the thickness of the corneal epithelium was uneven; the arrangement of the epithelial cells was disordered; and, some corneal epithelial cells were swollen. The results of Congo red staining, Masson’s trichrome staining and Periodic acid-Schiff staining were positive, while that of Alcian blue staining was negative. Under a transmission electron microscope, deposition of high electron density substances between epithelial and basal cells, and, apoptosis of basal cells were observed. Many high electron density depositions were observed in the sub-epithelial and anterior corneal matrix. CONCLUSION: In the Chinese family of recurrent corneal dystrophy with R124L gene mutation, the corneal epithelia of the recurrent cases are rougher, and the corneal depositions are extracellular amyloid fibrin.

3 A novel mutation of RPGR in a Chinese family with X-linked retinitis pigmentosa

Hui-Hui Sun , Jing-Cong Zhao , Su-Ling Yang , Jin-Dou Shi , Yun-Shuo Wei , Jian-Cang Wang , Feng Gu , Lu Chen

2022, 15(9):1423-1430. DOI: 10.18240/ijo.2022.09.03

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AIM: To identify potential mutations and elucidate the clinical findings of male patients and female carriers of X-linked retinitis pigmentosa (XLRP) in a Chinese family. METHODS: A four generation pedigree was collected that consisted of 20 individuals. Genomic DNA was extracted from peripheral blood, and then the target fragments were amplified by PCR and sequenced directly. In addition, all affected patients and female carriers underwent comprehensively ophthalmic evaluation. RESULTS: A novel mutation c.2865G>A p.W955X in RPGR gene was identified of this family, including four affected individuals and eight carriers. All male patients, aging from 7 to 31y, tended to have more various, even potentially deleterious clinical features of RP. At the same time, individuals with heterozygous mutations (carriers) manifested a wide spectrum of clinical features. Herein, only two male patients and three female carriers manifested pathological myopia (PM). Among the female carriers, half of subjects who harbor poor visual acuity suffered esotropia or exotropia. Additionally, 16.7% and 66.7% of carriers had abnormal electroretinogram (ERG) and fundus, respectively. CONCLUSION: In this study, a novel mutation of the RPGR gene is identified, which broadens the spectrum of RPGR mutations, and elaborates the relationship between genotype and phenotype.

4 Effect of 0.01% atropine eyedrops on intraocular pressure in schoolchildren: a randomized clinical trial

Javaria Bukhari , Shi-Fei Wei , Shi-Ming Li , Wen-Zai An , Jia-Ling Du , Xin-Tong Liang , Jia-He Gan , Jia-Xin Tian , Wei-Ling Bai , Zhi-Ning Cai , Lei Yin , Ning-Li Wang

2022, 15(9):1431-1436. DOI: 10.18240/ijo.2022.09.04

[Abstract](661) [HTML](0) [PDF 443.10 K](712)

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AIM: To assess the effect of 0.01% atropine eye drops on intraocular pressure (IOP) in myopic children. METHODS: A placebo-controlled, double-masked, randomized study. Totally 220 children aged 6 to 12y with myopia ranging from -1.00 to -6.00 D in both eyes were enrolled. Children were randomized in a 1:1 ratio to either 0.01% atropine eye drops or a placebo group using generated random numbers. All participants underwent the examination of IOP and cycloplegic refraction at baseline, 6 and 12mo. The change of IOP and the proportion of subjects with increased IOP in atropine and placebo groups were compared. RESULTS: Of 220 children, 117 were boys (53.2%). A total of 159 (72.3%) participants completed the follow-up at the 1-year study. At baseline, the mean IOP was 15.74 mm Hg (95%CI, 15.13 to 16.34 mm Hg) for the 0.01% atropine group and 15.59 mm Hg (95%CI, 15.00 to 16.19 mm Hg) for placebo group (mean difference, 0.14 mm Hg; P=0.743) after adjusting for central corneal thickness at baseline. At one year follow-up, the mean change of IOP was 0.16 mm Hg (95%CI, -0.43 to 0.76 mm Hg) for the 0.01% atropine group and -0.11 mm Hg (95%CI, -0.71 to 0.50 mm Hg) for placebo group (mean difference, 0.27 mm Hg; P=0.525) after adjusting for central corneal thickness. The 51.4% of children have increased IOP in the 0.01% atropine group, compared with 45.9% in the placebo group (P=0.511). CONCLUSION: The 0.01% atropine eye drops do not significantly affect the risk of elevated IOP. It is relatively safer to use in the studies that try to minimize myopia progression. However, a further long-duration study is required to be validated.

5 Staged lensectomy and vitrectomy in the management of stage 5C retinopathy of prematurity with corneal opacification: long-term follow up

Ping Fei , Ting-Yi Liang , Jie Peng , Yu Xu , Jia Luo , Qi Zhang , Jia-Kai Li , Jiao Lyu , Pei-Quan Zhao

2022, 15(9):1437-1443. DOI: 10.18240/ijo.2022.09.05

[Abstract](452) [HTML](0) [PDF 1.12 M](597)

Abstract:
AIM: To verify the feasibility and safety of staged lensectomy and vitrectomy in stage 5C retinopathy of prematurity (ROP) with corneal opacification. METHODS: This was a retrospective, interventional, consecutive case series. Twenty-two eyes of 18 stage 5C ROP patients with corneal opacification were included. Regular combined lensectomy and vitrectomy were not prescribed due to the invisible fundus. Staged lensectomy and posterior vitrectomy were performed. The anatomical and visual outcomes were reviewed at the final follow-up visit. RESULTS: The mean gestational age of ROP patients was 29.3±1.6wk (range: 27-32wk), comprising 8 males and 10 females. The average birth weight was 1363.0±300.0 g. All the eyes had corneal opacity and flat or disappeared anterior chambers pre-operatively. Two eyes had complicated cataract and 7 eyes had retrolental fibroplasia. Six eyes had posterior pupillary synechiae or membranes. Seven (31.8%) eyes had vascularly active retinas. The average interval between two procedures was 6.8±4.6mo (2.5-18.5mo). After surgeries, all the patients had normal anterior chambers. Fourteen eyes had clear corneas. The intraocular pressure of 3 eyes with glaucoma was controlled by medication. Two eyes had ocular phthisis. The retina was reattached in 3 eyes and partially attached in 11 eyes. Visual acuity ranged from no light perception to hand motion. CONCLUSION: Staged lensectomy and vitrectomy are procedures that can halt progression to further complications and preserve some useful eyesight in stage 5C ROP patients with corneal opacification. The earlier the lensectomy is performed, the better the prognosis is.

6 Clinical value of phenylephrine testing in the upper and lower eyelids of patients with aponeurotic and congenital eyelid ptosis

Ozgun Melike Gedar Totuk , Meltem Guzin Altinel , Ayse Yagmur Kanra , Umit Aykan

2022, 15(9):1444-1452. DOI: 10.18240/ijo.2022.09.06

[Abstract](661) [HTML](0) [PDF 458.80 K](513)

Abstract:
AIM: To characterize the phenylephrine test in aponeurotic and congenital eyelid ptosis, to determine the appropriate timing of the phenylephrine test, and to assess the responses of the upper and lower eyelids. METHODS: This was a retrospective analysis of 140 eyes of 87 patients (mean age 52.29±16.45y; 22 males, 65 females) with upper eyelid ptosis. Totally 88.6% had aponeurotic and 11.4% had congenital ptosis. For the evaluation of the responses of the upper and lower eyelids to topical 2.5% phenylephrine, the scleral show height, the marginal reflex distance (MRD) between the inferior margin of the upper eyelid and pupillary light reflex (MRD1), and between the central portion of the lower eyelid and pupillary light reflex (MRD2) were measured at the 2nd, 5th, and 15th minutes. The changes of MRD1 and MRD2 with time (ΔMRD1 and ΔMRD2) were evaluated. RESULTS: The mean MRD1, MRD2, and scleral show heights increased within 5min after testing, remaining largely stable between the 5th-15th minutes. The percentage of eyes with a greater response in MRD1 increased with increased severity of ptosis (P<0.05). Eyes with aponeurotic ptosis were more responsive to phenylephrine testing than congenital ptosis. The mild ptosis group had lower scleral show measurements and higher ΔMRD2 values. The ΔMRD1 and ΔMRD2 values were poorly correlated in all measurement times. CONCLUSION: Performing the phenylephrine test 5min after instilling the reagent is adequate to assess the maximum response of the upper and lower eyelids. The upper and lower eyelid responses in phenylephrine testing are poorly correlated. However, the ΔMRD2 is related with baseline scleral show degree that may be a postoperative predictive factor. Further studies are necessary to determine the relationship between the responses of the lower eyelids to phenylephrine testing.

7 Morphological changes in the iridocorneal angle and their relationship with intraocular pressure after infantile cataract surgery

Dan-Dan Wang , Zhang-Liang Li , Bing Zhang , Zi-Yi Lu , Wei-Chen Guan , Yun-E Zhao

2022, 15(9):1453-1459. DOI: 10.18240/ijo.2022.09.07

[Abstract](341) [HTML](0) [PDF 902.01 K](484)

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AIM: To evaluate morphological changes in the iridocorneal angle after pediatric cataract surgery. METHODS: Children who underwent primary infantile cataract surgery were included and 64 eyes from 41 children, including 18 with unilateral cataracts (18 eyes) and 23 with bilateral cataracts (46 eyes) were examined. All patients underwent two gonioscopic examinations to evaluate the iridocorneal angle, before the primary lens removal and before the secondary intraocular lens implantation. The anatomical changes in the iridocorneal angle and the relationship between intraocular pressure (IOP) and iridocorneal angle changes were also analyzed. RESULTS: The iridocorneal angle was wide in 64 eyes before and after surgery. The trabecular meshwork pigmentation, number of iris processes in every quadrant of the iridocorneal angle, and the width of the ciliary body band in the superior and inferior quadrants at the second gonioscopic examination were significantly increased compared to those at the first examination (P<0.001, P<0.05, P<0.05, and P<0.05, respectively). IOP gradually increased at 1mo after operation, and returned to the preoperative level at 3mo. However, IOP still increased significantly at 6 and 12mo. CONCLUSION: The main changes after pediatric cataract surgery include an increase in trabecular meshwork pigmentation and number of iris processes, IOP gradually increase and has positive correlation with trabecular meshwork pigmentation and anterior insertion of iris process.

8 Comparative analysis of visual quality between unilateral implantation of a trifocal intraocular lens and a rotationally asymmetric refractive multifocal intraocular lens

Na Hui , Mei-Fang Chu , Yan Li , Cong-Yi Wang , Lei Yu , Bo Ma

2022, 15(9):1460-1467. DOI: 10.18240/ijo.2022.09.08

[Abstract](464) [HTML](0) [PDF 1.06 M](546)

Abstract:
AIM: To compare visual quality after unilateral cataract surgery with implantation of trifocal intraocular lens (IOL) and asymmetric refractive multifocal IOL. METHODS: The prospective nonrandom, comparative study consisted of 60 eyes of 60 patients suffering unilateral cataract surgery with implantation of two different IOLs: AT LISA tri 839MP (30 eyes; Carl Zeiss Meditec, Germany) and LS-313 MF30 (30 eyes; Oculentis GmbH, Germany). Visual acuity, refractive outcome, contrast sensitivity, defocus curves, quality of vision, and optical phenomena were evaluated at 3mo postoperatively. RESULTS: There were no statistical differences between groups in uncorrected distance visual acuity (P=0.13) and uncorrected near visual acuity (P=0.54). In contrast, uncorrected intermediate visual acuity was better in trifocal group compared to the refractive multifocal group (P=0.02). No significant statistical between-group difference was detected in cylinder (P=0.43). Compared to trifocal group, spherical refraction and spherical equivalent in refractive multi focal group were more myopic (P<0.01). Under photopic conditions, no significant statistical differences were found between groups in contrast sensitivity at 3 and 6 cycles per degree (cpd). The refractive multifocal group performed better at 12 and 18 cpd than the trifocal group (P=0.01, P=0.034, respectively). The questionnaires of quality of vision and optical phenomena showed no differences between groups. CONCLUSION: Trifocal IOL is superior to refractive multifocal IOL in intermediate visual acuity. Rotationally asymmetric refractive multifocal IOL is more myopic in automated refraction and significantly better for the photopic contrast sensitivity at high frequency.

9 Efficacy of haptic sutured in-the-bag intraocular lens for intraocular lens-capsule complex stability: a comparison of three insertion methods

Yang Kyung Cho , Andrew Thomson , Balamurali K Ambati

2022, 15(9):1468-1475. DOI: 10.18240/ijo.2022.09.09

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Abstract:
AIM: To evaluate the efficacy and stability of haptic sutured in-the-bag intraocular lens (IOL) in eyes with zonular instability. METHODS: A total 60 eyes of 60 patients were included in this retrospective cohort study. Postoperative stability in three groups [haptic sutured IOL in the bag, IOL in the bag insertion with haptics oriented toward areas of zonulysis, IOL with capsular tension ring (CTR) in the bag insertion] were compared according to the IOL insertion methods. To evaluate the IOL stability, the changes of anterior chamber depth (ACD), refraction, contraction of anterior continuous curvilinear capsulotomy (CCC) area, and tilt of IOL were compared. RESULTS: There was no significant difference in change of ACD (-0.04±0.01 mm in group of haptic sutured IOL, -0.07±0.01 mm in group of CTR insertion) and refraction (0.05±0.05 D in group of haptic sutured IOL, 0.37±015 D in group of CTR insertion) between the group of haptic sutured IOL in the bag and CTR insertion group. But in comparison of CCC contraction and IOL tilt, CTR insertion group showed less contraction (1.00%±0.52%) and less IOL tilt (2.66°±0.11°) than the group of haptic sutured IOL in the bag (6.32%±1.36%, 3.47°±0.11°, respectively). The CTR insertion group showed the least CCC contraction and the least tilt. CONCLUSION: In eyes with zonular instability, the method of haptic sutured IOL in-the-bag shows comparable stability in ACD and refraction in comparison with IOL with CTR in the bag insertion. The method of IOL only in-the-bag insertion shows the largest contraction of CCC and the largest tilt of IOL.

10 Ultrasound biomicroscopic imaging demonstrate thinner ciliary body thickness in eyes with angle closure

Shi-Yan Chen , Na He , Yu-Jie Yan , Xiang Fan , Ling-Ling Wu

2022, 15(9):1476-1482. DOI: 10.18240/ijo.2022.09.10

[Abstract](352) [HTML](0) [PDF 569.61 K](538)

Abstract:
AIM: To compare the ciliary body thickness between eyes with primary angle closure (PAC) and primary angle-closure glaucoma (PACG) with the normal eyes, and to investigate the association between ciliary body thickness and ciliary processes situation. METHODS: In this cross-sectional study, 57 patients with PAC/PACG were matched to 57 normal subjects after propensity score matching (PSM) adjusting for age and gender. All subjects underwent conventional ocular examinations and ultrasound biomicroscopy (UBM) examination, among which the patients with PAC/PACG performed the examinations one month after laser peripheral iridotomy (LPI). Quantitative parameters were measured, which included ciliary body thickness at the position of 1 mm posterior to the scleral spur (CBT1), trabecular-ciliary process distance (TCPD) and trabecular-ciliary process angle (TCA). RESULTS: Eyes with PAC/PACG presented significantly thinner CBT1, shorter TCPD and smaller TCA (P<0.001) than the normal eyes, both in comparison of the means of four quadrants and in comparisons of each quadrant. After removing images with peripheral anterior synechia (PAS), the same results were also found in comparisons between the two groups. Significant correlations were found between TCPD (R2=0.537, P<0.001) and TCA (R2=0.517, P<0.001) with CBT1. CONCLUSION: Eyes with PAC/PACG have thinner ciliary body thickness and more anteriorly situated ciliary processes. Thinner ciliary body thickness is associated with anterior situation of the ciliary processes.

11 Reproducibility of macular perfusion parameters in non-proliferative diabetic retinopathy patients by two different OCTA sweep modes

Shen Qu , Ao Rong , Yun-Li Niu , Xin Liu , Yu-Shan Zhang , Chun-Yu Liu , Yan-Long Bi

2022, 15(9):1483-1487. DOI: 10.18240/ijo.2022.09.11

[Abstract](525) [HTML](0) [PDF 330.21 K](586)

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AIM: To assess the reproducibility of macular perfusion parameters in non-proliferative diabetic retinopathy (NPDR) patients measured by different examiners and two different sweep modes of optical coherence tomography angiography (OCTA). METHODS: Ninety-eight (98 eyes) patients with NPDR were included in this study. All participates were performed three times using Cirrus OCTA with Angiography 3×3 mm2 and 6×6 mm2 sweep mode by two examiners. The macular foveal avascular zone (FAZ) and vessel density (VD) in the superficial retinal layer (SRL) were measured. The reproducibility of the measurements was evaluated with intraclass correlation coefficients (ICC) and coefficient of variation (CoV). RESULTS: The intra-mode ICCs of Angiography 3×3 mm2 and 6×6 mm2 sweep mode were 0.957 to 0.959 and 0.964 to 0.977, respectively; and the inter-mode ICCs were 0.962 to 0.970. The intra-examiner ICCs of macular perfusion parameters were >0.950; and the inter-examiner ICCs were 0.928 to 0.969. All CoVs were <1.0%. CONCLUSION: Cirrus OCTA can measure macular perfusion parameters in NPDR patients with excellent reproducibility. The measurements of FAZ and VD in the SRL determined by Angiography 3×3 mm2 and 6×6 mm2 sweep mode are highly consistent and both sweep modes are suitable for macular perfusion parameters measurement.

12 Peripapillary vessel density and retinal nerve fiber layer thickness changes in early diabetes retinopathy

Xiang-Ning Wang , Xuan Cai , Ting-Ting Li , Da Long , Qiang Wu

2022, 15(9):1488-1495. DOI: 10.18240/ijo.2022.09.12

[Abstract](565) [HTML](0) [PDF 1.53 M](635)

Abstract:
AIM: To perform a quantitative analysis of the peripapillary vessel density (VD) and retinal nerve fiber layer (RNFL) thickness changes in patients with early stage of diabetic retinopathy (DR). METHODS: In this case-control study, swept-source optical coherence tomography angiography (SS-OCTA) imaging was used to examine diabetic and age-matched healthy subjects. The optic disc HD 6×6 mm2 blood flow imaging scan mode was selected. Automatic software was used to measure the peripapillary VD, capillary vessel density (CVD), and RNLF in an optic nerve head (ONH) filed based on the Garway-Heath map. In addition, the correlation between peripapillary VD, CVD, and RNFL was further investigated. RESULTS: The cohort consisted of 32 healthy individuals and 72 patients with diabetes (34 eyes with no DR and 38 eyes with mild-moderate NPDR). Peripapillary VD decreased in the mild-moderate NPDR group compared to the control group in most regions (P<0.05). Peripapillary CVD and RNFL thickness were significantly lower in the mild-moderate NPDR group in the superior temporal (ST) quadrants (P=0.018, P=0.030). In the correlation analysis of each region, the RNFL thickness in the NS region was positively correlated with the peripapillary VD and CVD (r=0.233, P=0.05; r=0.288, P=0.015). In the TI region, the RNFL thickness was positively correlated with the peripapillary CVD (r=0.237, P=0.047). CONCLUSION: The measurement based on the ONH topographic map may be helpful in detecting functional and structural impairments in DR. The peripapillary VD, CVD and RNFL decrease in early DR, and the RNFL thickness altered in association with the CVD or/and VD in some regions.

13 Inner limiting membrane peeling prevents secondary epiretinal membrane after vitrectomy for proliferative diabetic retinopathy

Rong-Han Wu , Ming-Na Xu , Ke Lin , Ming-Xue Ren , Han Wen , Ke-Mi Feng , Hong-Jia Zhou , Nived Moonasar , Zhong Lin

2022, 15(9):1496-1501. DOI: 10.18240/ijo.2022.09.13

[Abstract](351) [HTML](0) [PDF 516.41 K](524)

Abstract:
AIM: To evaluate the role of internal limiting membrane (ILM) peeling in preventing secondary epiretinal membrane (ERM) formation in pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: This retrospective study analyzed the medical records of patients who underwent PPV for PDR and were followed up for minimum 3mo. ILM peeling was performed based on the intraoperative surgeons’ judgments. ERM was assessed by optical coherence tomography photography. The relationship between ILM peeling and postoperative ERM was analyzed. RESULTS: In total, 212 eyes from 197 patients were included in this study. The incidence of secondary ERM in the ILM non-peeling group was significantly higher than that in the ILM peeling group (37.0% vs 14.0%; P<0.001). Multivariate logistical regression revealed that ILM peeling was highly associated with the prevention of secondary ERM development [odds ratio 0.38; 95% confidence interval 0.17-0.86; P<0.05]. CONCLUSION: ILM peeling during PPV for PDRs can effectively reduce the incidence of secondary ERM development and is worth consideration by vitreoretinal surgeons.

14 Various configuration types of the foveal avascular zone with related factors in normal Chinese adults with or without myopia assessed by swept-source OCT angiography

Yan-Min Dong , Hai-Yan Zhu , Zhen-Hui Liu , Shu-Ying Fu , Ke Wang , Li-Ping Du , Xue-Min Jin

2022, 15(9):1502-1510. DOI: 10.18240/ijo.2022.09.14

[Abstract](529) [HTML](0) [PDF 2.68 M](597)

Abstract:
AIM: To describe the morphological characteristics of foveal avascular zone (FAZ) in normal Chinese adults with or without myopia by swept-source optical coherence tomography angiography (SS-OCTA) and analyze the possible associated factors. METHODS: Normal Chinese adults with or without myopia aged between 18 and 60y were recruited into the study. One eye in each individual was randomly selected for scanning using SS-OCTA. FAZ parameters, central retinal thickness (CRT) and central choroidal thickness (CCT) were then analyzed. Correlations between systemic and ocular variables and FAZ parameters were subsequently evaluated. The subgroup analysis based on refractive error was also carried out. RESULTS: In total, 127 eyes out of 127 normal subjects were finally included in the study (mean age 29.5±8.22y, 61 males and 66 females). The pattern of FAZ was variable: round configuration in 28 eyes (22%), quadrilateral configuration in 23 eyes (18%), pentagonal configuration in 20 eyes (16%), oval configuration in 15 eyes (12%), triangular configuration in 6 eyes (5%) and irregular configuration in 35 eyes (28%). The mean area of FAZ was 0.37±0.12 mm2. Females had a larger FAZ (0.41±0.11 mm2 vs 0.32±0.11 mm2) compared with that of males (P<0.01). All myopic individuals showed smaller FAZ area and perimeter compared with that of normal individuals (P<0.01). There was no obvious correlation between age and FAZ. In the univariate regression analysis, both axial length (AL) and refractive error were significantly related to FAZ parameters. However, only CRT showed negative correlation with FAZ in the multivariate regression analysis. CONCLUSION: The pattern of FAZ configuration in normal Chinese adults with or without myopia is highly variable. Establishing quantitative parameters of FAZ would not only provide details of macular pathophysiology but could possibly contribute as a biomarker in disease staging.

15 Comparison of intravitreal aflibercept and dexamethasone implant in the treatment of macular edema associated with diabetic retinopathy or retinal vein occlusion: a Meta-analysis and systematic review

Xuan-Yu Qiu , Xiao-Fei Hu , Ya-Zhou Qin , Ji-Xian Ma , Qiu-Ping Liu , Li Qin , Jing-Ming Li

2022, 15(9):1511-1519. DOI: 10.18240/ijo.2022.09.15

[Abstract](645) [HTML](0) [PDF 2.84 M](748)

Abstract:
AIM: To compare the efficacy and safety of intravitreal aflibercept with dexamethasone implant in the treatment of macular edema (ME) associated with diabetic retinopathy (DR) or retinal vein occlusion (RVO). METHODS: A comprehensive search of studies comparing dexamethasone and aflibercept in patients with ME was conducted at PubMed, Embase, and Cochrane Central Register of Controlled Trials from the beginning of library to April 16, 2021. Extracting the data including best-corrected visual acuity (BCVA), central retinal thickness (CRT), number of injections and serious adverse events (SAEs) from the final qualified articles. RevMan 5.3 software was used for Meta-analysis of the included studies. RESULTS: Totally 7 studies with 369 eyes were included. The causes of ME in the final screening study included RVO and DR. Compared with the aflibercept treatment group, the BCVA of the dexamethasone implant treatment group showed no significant difference in the follow-up for 3mo [mean difference (MD): -0.05, 95% confidence interval (CI): -0.11, 0.02; P=0.17] and 12mo (MD: -0.01, 95%CI: -0.38, 0.37; P=0.98), but it was slightly worse than the aflibercept group at 6mo (MD: 0.12, 95%CI: 0.03, 0.21; P=0.008). In terms of CRT reduction, there was no significant difference between the two groups at 3mo (MD: -28.14, 95%CI: -79.95, 23.67; P=0.29), 6mo (MD: 27.67, 95%CI: -84.89, 140.24; P=0.63), and 12mo (MD: -59.00, 95%CI: -127.37,9.37; P=0.09). However, dexamethasone implant had fewer injections, but more adverse events such as elevated intraocular pressure (IOP) and cataract. CONCLUSION: Intravitreal injection of aflibercept and dexamethasone implant can both effectively increase BCVA and reduce CRT. Compared with aflibercept, dexamethasone implant is not inferior in improving vision and reducing CRT in the initial treatment period (3mo) and long-term treatment period (12mo). Besides, it has fewer injections and more likely to cause elevated IOP and cataract.

16 Interferon-gamma release assays in tuberculous uveitis: a comprehensive review

Usanee Tungsattayathitthan , Sutasinee Boonsopon , Nattaporn Tesavibul , Tararaj Dharakul , Pitipol Choopong

2022, 15(9):1520-1528. DOI: 10.18240/ijo.2022.09.16

[Abstract](432) [HTML](0) [PDF 786.47 K](556)

Abstract:
Tuberculous uveitis (TBU) comprises a broad clinical spectrum of ocular manifestations, making its diagnosis challenging. Ophthalmologists usually require evidence from investigations to confirm or support a clinical diagnosis of TBU. Since direct isolation of the causative organism from ocular specimens has limitations owing to the small volume of the ocular specimens, resultant test positivities are low in yield. Immunodiagnostic tests, including the tuberculin skin test and interferon-gamma release assays (IGRAs), can help support a clinical diagnosis of TBU. Unlike the tuberculin skin test, IGRAs are in vitro tests that require a single visit and are not affected by prior Bacillus Calmette-Guerin vaccination. Currently, available IGRAs consist of different techniques and interpretation methods. Moreover, newer generations have been developed to improve the sensitivity and ability to detect active tuberculosis. This narrative review collates salient practice points as a reference for general ophthalmologists, such as evidence for the utilization of IGRAs in patients with suspected TBU, and summarizes basic knowledge and details of clinical applications of these tests in a clinical setting.

17 Ocular stem cells: a narrative review of current clinical trials

Konstadinos Sotiropulos , Dimitrios Kourkoutas , Diamantis Almaliotis , Katherine Ploumidou , Vasileios Karampatakis

2022, 15(9):1529-1537. DOI: 10.18240/ijo.2022.09.17

[Abstract](528) [HTML](0) [PDF 414.22 K](641)

Abstract:
Stem cells are undifferentiated cells showcasing a remarkable capacity of self-replenishing and differentiating into mature cells. Their ability to proliferate connotes that a designated stem cell source is capable of generating an unrestricted number of mature cells. The ever-increasing comprehension of position, activity, and function of ocular stem cells has led to rapid progress and incessant improvement of possible procedures and therapies. A narrative review was conducted to summarize the current evidence on clinical trials and respective literature, regarding current evolution in the field of ocular regenerative medicine. We tried to ascertain the safety of experimental and clinical procedures, their effectiveness, and the ethical repercussion of their use.

18 Different compression sutures combined with intracameral air injection for acute corneal hydrops

Xin Liu , Hua Li , Shen Qu , Qiao Yu , Hui Lin , Yan-Long Bi

2022, 15(9):1538-1543. DOI: 10.18240/ijo.2022.09.18

[Abstract](328) [HTML](0) [PDF 964.01 K](595)

Abstract:
AIM: To evaluate the efficacy and safety of full-thickness sutures combined with intracameral air injection (FTS-AI) versus pre-Descemet’s membrane sutures combined with intracameral air injection (PDS-AI) in the management of acute corneal hydrops in keratoconus. METHODS: The research included 8 patients (8 eyes) suffering from acute corneal hydrops caused by keratoconus. Four patients were randomly assigned to FTS-AI. And the other four were randomly assigned to PDS-AI. Corneal oedema, visual acuity, corneal thickness were assessed during follow-up. RESULTS: The demographics, preoperative duration of symptoms and severity of corneal hydrops between the two groups were not significantly different. The mean corneal oedema resolution time after FTS-AI and PDS-AI were 11±1.15 and 15±1.41d, respectively (P=0.005). The maximum corneal thickness of the scarred region decreased in both groups at one week postoperatively (P<0.05). No obvious difference was found in the mean maximal corneal thickness between the two groups postoperatively. The BCVA improved significantly after FTS-AI and PDS-AI at three months postoperatively. No obvious difference was found in the BCVA after FTS-AI and PDS-AI at three months postoperatively. CONCLUSION: FTS-AI and PDS-AI are safe and effective therapies to accelerate the resolution of corneal oedema in acute corneal hydrops secondary to keratoconus. Despite faster resolution of corneal oedema in the FTS-AI group, we recommend PDS-AI to avoid potential endothelium cell damage.

19 COVID-19 infection with keratitis as the first clinical manifestation

Dong-Mei Zuo , Lin-Ping Xue , Heng Fan , Sheng-Li Yang , Liang-Chang Li , Ji-Hong Luo , Shuo Zang , Jun Xiao

2022, 15(9):1544-1548. DOI: 10.18240/ijo.2022.09.19

[Abstract](554) [HTML](0) [PDF 611.19 K](709)

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AIM: To report a case which keratitis is the first clinical manifestation of COVID-19 that occurred 3d earlier than the common COVID-19 symptoms. METHODS: Regular slit lamp examination, corneal scraping test, and chest computed tomography (CT) were performed for patients with COVID-19 infection. The ophthalmologic treatment included ganciclovir eye drop (50 mg/mL, 6 times/d). The treatment for diarrhea included Guifu Lizhong pills (TID). The antiviral therapy consisted of oseltamivir (75 mg capsule Q12H); therapy preventing bacterial infection consisted of azithromycin (250 mg tablet QD) and moxifloxacin (0.4 g tablet Q12H); and therapy for cough relief and fever prevention consisted of Chinese herbal decoction. RESULTS: A 35-year-old male suddenly suffered pain, photophobia, and tears in his right eye for one day without systemic COVID-19 symptoms. Patient was diagnosed with keratitis, which was seemingly different from common keratitis. Ganciclovir eye drop was initiated. The corneal scraping test for COVID-19 was positive. The chest CT images were abnormal confirming the diagnosis of COVID-19 infection. The antiviral and antibacterial therapies were initiated. Chinese herbal therapy was used for cough relief and fever prevention. After roughly two weeks, patient recovered from COVID-19. CONCLUSION: A new type of keratitis, atypical keratitis, is a clinical manifestation of COVID-19, and this clinical manifestation could appear 3d earlier than fever and cough. The earlier a COVID-19 clinical manifestation is identified, the earlier can a patient be directed to stay at home, and significantly fewer people would be infected.

20 Efficacy and safety of intravitreal HLX04-O, an anti-VEGF monoclonal antibody, for the treatment of wet age-related macular degeneration

Zhen Zhang , Ying Wu , Ya-Li Lyu , Meng-Qi Chang , Qiu-Jin Xu , Yi-Ming Liu , Wen-Ying Kang , Qing-Yu Wang , Chuan-Ling Li

2022, 15(9):1549-1553. DOI: 10.18240/ijo.2022.09.20

[Abstract](640) [HTML](0) [PDF 1.64 M](558)

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AIM: To evaluate the efficacy and safety of HLX04-O, an investigational ophthalmic formulation of HLX04 (bevacizumab biosimilar) for intravitreal injection, as a treatment for wet age-related macular degeneration (wAMD) in a phase 1/2 clinical trial (NCT04993352). METHODS: Eligible patients with wAMD were enrolled to receive HLX04-O intravitreal injections at a dose of 1.25 mg/0.05 mL every four weeks. Efficacy and adverse events were evaluated every month during study visits. RESULTS: A 76-year-old male with wAMD in his left eye participated in the trial and completed six cycles of HLX04-O intravitreal injections. Changes were observed in macular center point thickness (baseline vs last study visit, 437 vs 255 μm) and best-corrected visual acuity letter score (baseline vs last study visit, 36 vs 77) of the affected eye, which indicated an improvement in wAMD over treatment. No adverse events were reported by the data cutoff date. CONCLUSION: HLX04-O at 1.25 mg/0.05 mL every four weeks is well tolerated in this patient, demonstrating promising safety and efficacy in wAMD treatment. Large-scale studies are required to confirm the outcomes.

21 Novel technique of penetrating keratoplasty in high-risk grafts with significant corneal neovascularization

Mohammad Soleimani , Nader Mohammadi , Mansoor Shahriari , Morteza Karimi , Ahmed Alshaheeb , Atefeh Khalili , Mohammad Hossein Zamani , Kasra Cheraqpour

2022, 15(9):1554-1556. DOI: 10.18240/ijo.2022.09.21

[Abstract](269) [HTML](0) [PDF 503.33 K](455)

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22 Increasing rim height depth for safe femtosecond laser-assisted capsulotomy in intumescent white cataracts with liquified cortex

Beatriz Vidal-Villegas , José Antonio Gegúndez Fernández , Bárbara Burgos-Blasco , David Diaz-Valle , Ricardo Cuiña-Sardiña , Rosalía Méndez-Fernández , Pedro Arriola-Villalobos , Mayte Ariño-Gutiérrez , Jose Manuel Benítez-del-Castillo

2022, 15(9):1557-1559. DOI: 10.18240/ijo.2022.09.22

[Abstract](280) [HTML](0) [PDF 1.43 M](479)

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23 Clinical analysis of bilateral acute depigmentation of the iris: first reported case in China

Ting Wang , Wan-Man Wu , Fu-Yan Zhang , Xu Jia

2022, 15(9):1560-1562. DOI: 10.18240/ijo.2022.09.23

[Abstract](251) [HTML](0) [PDF 633.12 K](468)

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24 Dual histologic variants of schwannomas in orbital schwannomatosis

Gary John V. Mercado , Leandro Victor L. Arcena , Elaine Yatco-Omańa , Elizabeth Y. Arcellana-Nuqui , Roland Joseph D. Tan

2022, 15(9):1563-1565. DOI: 10.18240/ijo.2022.09.24

[Abstract](440) [HTML](0) [PDF 1.16 M](489)

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25 Suggestions on gut-eye cross-talk: about the chalazion

Carla Enrica Gallenga , Marco Mura , Pier Enrico Gallenga

2022, 15(9):1566-1566. DOI: 10.18240/ijo.2022.09.25

[Abstract](298) [HTML](0) [PDF 202.86 K](476)

Abstract:

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Volume 15,Issue 9,2022 Table of Contents