Volume 16,Issue 9,2023 Table of Contents

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    • 1  Artificial intelligence in ophthalmology
    Peter Wiedemann
    2023, 16(9):1357-1360. DOI: 10.18240/ijo.2023.09.01
    [Abstract](481) [HTML](0) [PDF 493.32 K](755)
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    2  Guidelines on clinical research evaluation of artificial intelligence in ophthalmology (2023)
    Wei-Hua Yang ,  Yi Shao ,  Yan-Wu Xu ,  Expert Workgroup of Guidelines on Clinical Research Evaluation of Artificial Intelligence in Ophthalmology () ,  Ophthalmic Imaging ,  Intelligent Medicine Branch of Chinese Medicine Education Association ,  Intelligent Medicine Committee of Chinese Medicine Education Association
    2023, 16(9):1361-1372. DOI: 10.18240/ijo.2023.09.02
    [Abstract](585) [HTML](0) [PDF 962.90 K](1037)
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    With the upsurge of artificial intelligence (AI) technology in the medical field, its application in ophthalmology has become a cutting-edge research field. Notably, machine learning techniques have shown remarkable achievements in diagnosing, intervening, and predicting ophthalmic diseases. To meet the requirements of clinical research and fit the actual progress of clinical diagnosis and treatment of ophthalmic AI, the Ophthalmic Imaging and Intelligent Medicine Branch and the Intelligent Medicine Committee of Chinese Medicine Education Association organized experts to integrate recent evaluation reports of clinical AI research at home and abroad and formed a guideline on clinical research evaluation of AI in ophthalmology after several rounds of discussion and modification. The main content includes the background and method of developing this guideline, an introduction to international guidelines on the clinical research evaluation of AI, and the evaluation methods of clinical ophthalmic AI models. This guideline introduces general evaluation methods of clinical ophthalmic AI research, evaluation methods of clinical ophthalmic AI models, and commonly-used indices and formulae for clinical ophthalmic AI model evaluation in detail, and amply elaborates the evaluation methods of clinical ophthalmic AI trials. This guideline aims to provide guidance and norms for clinical researchers of ophthalmic AI, promote the development of regularization and standardization, and further improve the overall level of clinical ophthalmic AI research evaluations.
    3  Guidelines for the application of artificial intelligence in the diagnosis of anterior segment diseases (2023)
    Yi Shao ,  Ying Jie ,  Zu-Guo Liu ,  Expert Workgroup of Guidelines for the application of artificial intelligence in the diagnosis of anterior segment diseases() ,  Ophthalmic Imaging ,  Intelligent Medicine Branch of Chinese Medicine Education Association ,  Ophthalmology Committee of International Association of Translational Medicine ,  Chinese Ophthalmic Imaging Study Groups
    2023, 16(9):1373-1385. DOI: 10.18240/ijo.2023.09.03
    [Abstract](249) [HTML](0) [PDF 2.83 M](997)
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    The landscape of ophthalmology has observed monumental shifts with the advent of artificial intelligence (AI) technologies. This article is devoted to elaborating on the nuanced application of AI in the diagnostic realm of anterior segment eye diseases, an area ripe with potential yet complex in its imaging characteristics. Historically, AI's entrenchment in ophthalmology was predominantly rooted in the posterior segment. However, the evolution of machine learning paradigms, particularly with the advent of deep learning methodologies, has reframed the focus. When combined with the exponential surge in available electronic image data pertaining to the anterior segment, AI's role in diagnosing corneal, conjunctival, lens, and eyelid pathologies has been solidified and has emerged from the realm of theoretical to practical. In light of this transformative potential, collaborations between the Ophthalmic Imaging and Intelligent Medicine Subcommittee of the China Medical Education Association and the Ophthalmology Committee of the International Translational Medicine Association have been instrumental. These eminent bodies mobilized a consortium of experts to dissect and assimilate advancements from both national and international quarters. Their mandate was not limited to AI's application in anterior segment pathologies like the cornea, conjunctiva, lens, and eyelids, but also ventured into deciphering the existing impediments and envisioning future trajectories. After iterative deliberations, the consensus synthesized herein serves as a touchstone, assisting ophthalmologists in optimally integrating AI into their diagnostic decisions and bolstering clinical research. Through this guideline, we aspire to offer a comprehensive framework, ensuring that clinical decisions are not merely informed but transformed by AI. By building upon existing literature yet maintaining the highest standards of originality, this document stands as a testament to both innovation and academic integrity, in line with the ethos of renowned journals such as Ophthalmology.
    4  Artificial intelligence assisted pterygium diagnosis: current status and perspectives
    Bang Chen ,  Xin-Wen Fang ,  Mao-Nian Wu ,  Shao-Jun Zhu ,  Bo Zheng ,  Bang-Quan Liu ,  Tao Wu ,  Xiang-Qian Hong ,  Jian-Tao Wang ,  Wei-Hua Yang
    2023, 16(9):1386-1394. DOI: 10.18240/ijo.2023.09.04
    [Abstract](236) [HTML](0) [PDF 1.25 M](767)
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    Pterygium is a prevalent ocular disease that can cause discomfort and vision impairment. Early and accurate diagnosis is essential for effective management. Recently, artificial intelligence (AI) has shown promising potential in assisting clinicians with pterygium diagnosis. This paper provides an overview of AI-assisted pterygium diagnosis, including the AI techniques used such as machine learning, deep learning, and computer vision. Furthermore, recent studies that have evaluated the diagnostic performance of AI-based systems for pterygium detection, classification and segmentation were summarized. The advantages and limitations of AI-assisted pterygium diagnosis and discuss potential future developments in this field were also analyzed. The review aims to provide insights into the current state-of-the-art of AI and its potential applications in pterygium diagnosis, which may facilitate the development of more efficient and accurate diagnostic tools for this common ocular disease.
    5  Research progress in artificial intelligence assisted diabetic retinopathy diagnosis
    Yun-Fang Liu ,  Yu-Ke Ji ,  Fang-Qin Fei ,  Nai-Mei Chen ,  Zhen-Tao Zhu ,  Xing-Zhen Fei
    2023, 16(9):1395-1405. DOI: 10.18240/ijo.2023.09.05
    [Abstract](236) [HTML](0) [PDF 715.19 K](767)
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    Diabetic retinopathy (DR) is one of the most common retinal vascular diseases and one of the main causes of blindness worldwide. Early detection and treatment can effectively delay vision decline and even blindness in patients with DR. In recent years, artificial intelligence (AI) models constructed by machine learning and deep learning (DL) algorithms have been widely used in ophthalmology research, especially in diagnosing and treating ophthalmic diseases, particularly DR. Regarding DR, AI has mainly been used in its diagnosis, grading, and lesion recognition and segmentation, and good research and application results have been achieved. This study summarizes the research progress in AI models based on machine learning and DL algorithms for DR diagnosis and discusses some limitations and challenges in AI research.
    6  Artificial intelligence-aided diagnosis and treatment in the field of optometry
    Hua-Qing Du ,  Qi Dai ,  Zu-Hui Zhang ,  Chen-Chen Wang ,  Jing Zhai ,  Wei-Hua Yang ,  Tie-Pei Zhu
    2023, 16(9):1406-1416. DOI: 10.18240/ijo.2023.09.06
    [Abstract](266) [HTML](0) [PDF 827.45 K](967)
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    With the rapid development of computer technology, the application of artificial intelligence (AI) to ophthalmology has gained prominence in modern medicine. As modern optometry is closely related to ophthalmology, AI research on optometry has also increased. This review summarizes current AI research and technologies used for diagnosis in optometry, related to myopia, strabismus, amblyopia, optical glasses, contact lenses, and other aspects. The aim is to identify mature AI models that are suitable for research on optometry and potential algorithms that may be used in future clinical practice.
    7  Evaluation of a novel deep learning based screening system for pathologic myopia
    Pei-Fang Ren ,  Xu-Yuan Tang ,  Chen-Ying Yu ,  Li-Li Zhu ,  Wei-Hua Yang ,  Ye Shen
    2023, 16(9):1417-1423. DOI: 10.18240/ijo.2023.09.07
    [Abstract](175) [HTML](0) [PDF 2.82 M](743)
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    AIM: To evaluate the clinical application value of the artificial intelligence assisted pathologic myopia (PM-AI) diagnosis model based on deep learning. METHODS: A total of 1156 readable color fundus photographs were collected and annotated based on the diagnostic criteria of Meta-pathologic myopia (PM) (2015). The PM-AI system and four eye doctors (retinal specialists 1 and 2, and ophthalmologists 1 and 2) independently evaluated the color fundus photographs to determine whether they were indicative of PM or not and the presence of myopic choroidal neovascularization (mCNV). The performance of identification for PM and mCNV by the PM-AI system and the eye doctors was compared and evaluated via the relevant statistical analysis. RESULTS: For PM identification, the sensitivity of the PM-AI system was 98.17%, which was comparable to specialist 1 (P=0.307), but was higher than specialist 2 and ophthalmologists 1 and 2 (P<0.001). The specificity of the PM-AI system was 93.06%, which was lower than specialists 1 and 2, but was higher than ophthalmologists 1 and 2. The PM-AI system showed the Kappa value of 0.904, while the Kappa values of specialists 1, 2 and ophthalmologists 1, 2 were 0.968, 0.916, 0.772 and 0.730, respectively. For mCNV identification, the AI system showed the sensitivity of 84.06%, which was comparable to specialists 1, 2 and ophthalmologist 2 (P>0.05), and was higher than ophthalmologist 1. The specificity of the PM-AI system was 95.31%, which was lower than specialists 1 and 2, but higher than ophthalmologists 1 and 2. The PM-AI system gave the Kappa value of 0.624, while the Kappa values of specialists 1, 2 and ophthalmologists 1 and 2 were 0.864, 0.732, 0.304 and 0.238, respectively. CONCLUSION: In comparison to the senior ophthalmologists, the PM-AI system based on deep learning exhibits excellent performance in PM and mCNV identification. The effectiveness of PM-AI system is an auxiliary diagnosis tool for clinical screening of PM and mCNV.
    8  Prediction of SMILE surgical cutting formula based on back propagation neural network
    Dong-Qing Yuan ,  Fu-Nan Tang ,  Chun-Hua Yang ,  Hui Zhang ,  Ying Wang ,  Wei-Wei Zhang ,  Liu-Wei Gu ,  Qing-Huai Liu
    2023, 16(9):1424-1430. DOI: 10.18240/ijo.2023.09.08
    [Abstract](150) [HTML](0) [PDF 1.50 M](626)
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    AIM: To predict cutting formula of small incision lenticule extraction (SMILE) surgery and assist clinicians in identifying candidates by deep learning of back propagation (BP) neural network. METHODS: A prediction program was developed by a BP neural network. There were 13 188 pieces of data selected as training validation. Another 840 eye samples from 425 patients were recruited for reverse verification of training results. Precision of prediction by BP neural network and lenticule thickness error between machine learning and the actual lenticule thickness in the patient data were measured. RESULTS: After training 2313 epochs, the predictive SMILE cutting formula BP neural network models performed best. The values of mean squared error and gradient are 0.248 and 4.23, respectively. The scatterplot with linear regression analysis showed that the regression coefficient in all samples is 0.99994. The final error accuracy of the BP neural network is -0.003791±0.4221102 μm. CONCLUSION: With the help of the BP neural network, the program can calculate the lenticule thickness and residual stromal thickness of SMILE surgery accurately. Combined with corneal parameters and refraction of patients, the program can intelligently and conveniently integrate medical information to identify candidates for SMILE surgery.
    9  Bibliometric analysis of artificial intelligence and optical coherence tomography images: research hotspots and frontiers
    Hai-Wen Feng ,  Jun-Jie Chen ,  Zhi-Chang Zhang ,  Shao-Chong Zhang ,  Wei-Hua Yang
    2023, 16(9):1431-1440. DOI: 10.18240/ijo.2023.09.09
    [Abstract](216) [HTML](0) [PDF 2.28 M](930)
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    AIM: To explore the latest application of artificial intelligence (AI) in optical coherence tomography (OCT) images, and to analyze the current research status of AI in OCT, and discuss the future research trend. METHODS: On June 1, 2023, a bibliometric analysis of the Web of Science Core Collection was performed in order to explore the utilization of AI in OCT imagery. Key parameters such as papers, countries/regions, citations, databases, organizations, keywords, journal names, and research hotspots were extracted and then visualized employing the VOSviewer and CiteSpace V bibliometric platforms. RESULTS: Fifty-five nations reported studies on AI biotechnology and its application in analyzing OCT images. The United States was the country with the largest number of published papers. Furthermore, 197 institutions worldwide provided published articles, where University of London had more publications than the rest. The reference clusters from the study could be divided into four categories: thickness and eyes, diabetic retinopathy (DR), images and segmentation, and OCT classification. CONCLUSION: The latest hot topics and future directions in this field are identified, and the dynamic evolution of AI-based OCT imaging are outlined. AI-based OCT imaging holds great potential for revolutionizing clinical care.
    10  17β-estradiol inhibits TGF-β-induced collagen gel contraction mediated by human Tenon fibroblasts via Smads and MAPK signaling pathways
    Cheng-Cheng Yang ,  Meng-Jie Liu ,  Yun-Ze-Peng Li ,  Zheng-Hua Xu ,  Yang Liu ,  Zi-Han Guo ,  Bin-Hui Li ,  Xiu-Xia Yang
    2023, 16(9):1441-1449. DOI: 10.18240/ijo.2023.09.10
    [Abstract](186) [HTML](0) [PDF 1.42 M](794)
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    AIM: To investigate the impact of 17β-estradiol on the collagen gels contraction (CGC) and inflammation induced by transforming growth factor (TGF)-β in human Tenon fibroblasts (HTFs). METHODS: HTFs were three-dimensionally cultivated in type I collagen-generated gels with or without TGF-β (5 ng/mL), 17β-estradiol (12.5 to 100 µmol/L), or progesterone (12.5 to 100 µmol/L). Then, the collagen gel diameter was determined to assess the contraction, and the development of stress fibers was analyzed using immunofluorescence staining. Immunoblot and gelatin zymography assays were used to analyze matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) being released into culture supernatants. Enzyme-linked immunosorbent assay (ELISA) and reverse transcription-quantitative polymerase chain reaction (RT-PCR) were used to detect interleukin (IL)-6, monocyte chemoattractant proteins (MCP)-1, and vascular endothelial growth factor (VEGF) in HTFs at the translational and transcriptional levels. The phosphorylation levels of Sma- and Mad-related proteins (Smads), mitogen-activated protein kinases (MAPKs), and protein kinase B (AKT) were measured by immunoblotting. Statistical analysis was performed using either the Tukey-Kramer test or Student's unpaired t-test to compare the various treatments. RESULTS: The CGC caused by TGF-β in HTFs was significantly inhibited by 17β-estradiol (25 to 100 µmol/L), and a statistically significant difference was observed when comparing the normal control group with 17β-estradiol concentrations exceeding 25 µmol/L (P<0.05). The suppressive impact of 17β-estradiol became evident 24h after administration and peaked at 72h (P<0.05), whereas progesterone had no impact. Moreover, 17β-estradiol attenuated the formation of stress fibers, and the production of MMP-3 and MMP-1 in HTFs stimulated by TGF-β. The expression of MCP-1, IL-6, and VEGF mRNA and protein in HTFs were suppressed by 100 µmol/L 17β-estradiol (P<0.01). Additionally, the phosphorylation of Smad2 Smad3, p38, and extracellular signal-regulated kinase (ERK) were downregulated (P <0.01). CONCLUSION: 17β-estradiol significantly inhibits the CGC and inflammation caused by TGF-β in HTFs. This inhibition is likely related to the suppression of stress fibers, inhibition of MMPs, and attenuation of Smads and MAPK (ERK and p38) signaling. 17β-estradiol may have potential clinical benefits in preventing scar development and inflammation in the conjunctiva.
    11  Effect of a novel tyrosine kinase inhibitor nintedanib on bFGF and VEGF concentrations in a rabbit retinal vein occlusion model
    Wei Fang ,  Jing Zhai ,  Zhen-Bin Qian ,  Hai-Dong Li ,  Meng-Di Wang ,  Li-Jun Shen
    2023, 16(9):1450-1455. DOI: 10.18240/ijo.2023.09.11
    [Abstract](110) [HTML](0) [PDF 1.95 M](603)
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    AIM: To evaluate whether a novel tyrosine kinase inhibitor nintedanib could inhibit basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) simultaneously for retinal vascular disease in vivo. METHODS: After a laser induced rabbit retinal vein occlusion (RVO) model was made, 0.5 mg of nintedanib was injected intravitreally in the left eye on the third day while the right eye was as a control. Intracameral samples were taken on the day before laser treatment and days 1, 3, 7, 14, 21, and 28 after treatment. Enzyme-linked immunosorbent assay (ELISA) was used to test the bFGF and VEGF-A concentrations in the aqueous humor. RESULTS: Both bFGF and VEGF-A rose significantly on the third day after laser treatment in both eyes. In the control eye the bFGF concentration peaked on the 14th day while the VEGF-A concentration dropped rapidly soon after the third day. After nintadanib injection in the study eye, both bFGF and VEGF-A showed a significant reduction on the 4th day (7th day after laser treatment) when compared to the control eye, and kept on low level in the following several weeks. CONCLUSION: Intravitreal injection of nintedanib can inhibit the expression of bFGF and VEGF in the process of RVO model to a certain extent, which is expected to become a new method for the treatment of retinal vascular diseases or fibrotic diseases.
    12  Effects of autophagy inhibitor 3-methyladenine on a diabetic mice model
    Hai-Wen Ren ,  Wen Yu ,  Ya-Nan Wang ,  Xin-Yi Zhang ,  Shun-Qiong Song ,  Shu-Yu Gong ,  Ling-Yao Meng ,  Chen Gan ,  Ben-Ju Liu ,  Quan Gong
    2023, 16(9):1456-1464. DOI: 10.18240/ijo.2023.09.12
    [Abstract](140) [HTML](0) [PDF 1.80 M](871)
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    AIM: To investigate the role of autophagy inhibitor 3-methyladenine (3-MA) on a diabetic mice model (DM) and the potential mechanism. METHODS: Male C57BL/6J mice were randomly divided into a normal control group (NC group) and an DM group. DM were induced by multiple low-dose intraperitoneal injection of streptozotocin (STZ) 60 mg/kg●d for 5 consecutive days. DM mice were randomly subdivided into untreated group (DM group), 3-MA (10 mg/kg●d by gavage) treated group (DM+3-MA group) and chloroquine (CQ; 50 mg/kg by intraperitoneal injection) treated group (DM+CQ group). The fasting blood glucose (FBG) levels were recorded every week. At the end of experiment, retinal samples were collected. The expression levels of pro-apoptotic proteins cleaved caspase-3, cleaved poly ADP-ribose polymerase 1 (PARP1) and Bax, anti-apoptotic protein Bcl-2, fibrosis-associated proteins Fibronectin and type 1 collagen α1 chain (COL1A1), vascular endothelial growth factor (VEGF), inflammatory factors interleukin (IL)-1β and tumor necrosis factor (TNF)-α, as well as autophagy related proteins LC3, Beclin-1 and P62 were determined by Western blotting. The oxidative stress indicators 8-hydroxydeoxyguanosine (8-OHdG) and malondialdehyde (MDA) were detected by commercial kits. RESULTS: Both 3-MA and CQ had short-term hypoglycemic effect on FBG and reduced the expression of VEGF and inflammatory factors IL-1β and TNF-α in DM mice. 3-MA also significantly alleviated oxidative stress indicators 8-OHdG and MDA, decreased the expression of fibrosis-related proteins Fibronectin and COL1A1, pro-apoptotic proteins cleaved caspase-3, cleaved PARP1, as well as the ratio of Bax/Bcl-2. CQ had no significant impact on the oxidative stress indicators, fibrosis, and apoptosis related proteins. The results of Western blotting for autophagy related proteins showed that the ratio of LC3 II/LC3 I and the expression of Beclin-1 in the retina of DM mice were decreased by 3-MA treatment, and the expression of P62 was further increased by CQ treatment. CONCLUSION: 3-MA has anti-apoptotic and anti-fibrotic effects on the retina of DM mice, and can attenuate retinal oxidative stress, VEGF expression and the production of inflammatory factors in the retina of DM mice. The underlying mechanism of the above effects of 3-MA may be related to its inhibition of early autophagy and hypoglycemic effect.
    13  LIN28A attenuates high glucose-induced retinal pigmented epithelium injury through activating SIRT1-dependent autophagy
    Dan-Qing Yu ,  Song-Ping Yu ,  Jing Wu ,  Li-Na Lan ,  Bang-Xun Mao
    2023, 16(9):1465-1474. DOI: 10.18240/ijo.2023.09.13
    [Abstract](141) [HTML](0) [PDF 7.89 M](821)
    Abstract:
    AIM: To evaluate the effects of LIN28A (human) on high glucose-induced retinal pigmented epithelium (RPE) cell injury and its possible mechanism. METHODS: Diabetic retinopathy model was generated following 48h of exposure to 30 mmol/L high glucose (HG) in ARPE-19 cells. Quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot tested the expression of the corresponding genes and proteins. Cell viability as well as apoptosis was determined through cell counting kit-8 (CCK-8) and flow cytometry assays. Immunofluorescence assay was adopted to evaluate autophagy activity. Caspase 3 activity, oxidative stress markers, and cytokines were appraised adopting their commercial kits, respectively. Finally, ARPE-19 cells were preincubated with EX527, a Sirtuin 1 (SIRT1) inhibitor, prior to HG stimulation to validate the regulatory mechanism. RESULTS: LIN28A was downregulated in HG-challenged ARPE-19 cells. LIN28A overexpression greatly inhibited HG-induced ARPE-19 cell viability loss, apoptosis, oxidative damage as well as inflammatory response. Meanwhile, the repressed autophagy and SIRT1 in ARPE-19 cells challenged with HG were elevated after LIN28A overexpression. In addition, treatment of EX527 greatly inhibited the activated autophagy following LIN28A overexpression and partly abolished the protective role of LIN28A against HG-elicited apoptosis, oxidative damage as well as inflammation in ARPE-19 cells. CONCLUSION: LIN28A exerts a protective role against HG-elicited RPE oxidative damage, inflammation, as well as apoptosis via regulating SIRT1/autophagy.
    14  Long-term outcomes of laser dacryoplasty combined with intubation using a new silicon tube in patients with lacrimal duct obstruction
    Yi-Meng Fan ,  Xiu-Xia Yin ,  Ning Gao ,  Zhao Liu
    2023, 16(9):1475-1481. DOI: 10.18240/ijo.2023.09.14
    [Abstract](149) [HTML](0) [PDF 908.98 K](576)
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    AIM: To determine the 15-year outcomes of laser dacryoplasty (LDP) in patients with lacrimal duct obstruction; and to evaluate LDP combined with intubation using a new silicone tube to treat complicated cases. METHODS: Patients with lacrimal duct obstruction and treated with LDP between April 2000 and April 2005 were investigated retrospectively. Totally 116 eyes with completed 15-year follow-up records were included in this study. For complicated cases (52 eyes of 52 patients), both LDP and intubation using a self-made silicon tube were performed. For patients with uncomplicated obstruction (64 eyes of 61 patients), only LDP was performed. Outcomes were assessed based on results of lacrimal irrigation and degree of symptoms during follow-up. RESULTS: At the follow-up time of 15y, 81 eyes achieved full success (69.8%); 21 eyes got improved (18.1%); and 14 eyes were considered failure (12.1%). The success rate was 71.2% (37/52 eyes) for complicated cases; and 68.8% (44/64 eyes) for uncomplicated cases. No statistically significant difference between two groups was observed (P=0.961). No postoperative complication was observed. CONCLUSION: LDP is a well-tolerated, simple, and effective procedure with satisfactory long-term outcomes in selected patients, which make it a good alternative to conventional dacryocystorhinostomy. In addition, intubation with the self-made mono-canalicular silicone tube facilitates the management of complicated cases with few complications.
    15  In vivo quantification of human aqueous veins by enhanced depth imaging optical coherence tomography and optical coherence tomography angiography images
    Zhi-Qi Chen ,  Wei Chen ,  Chao-Hua Deng ,  Jing-Min Guo ,  Hong Zhang ,  Jun-Ming Wang
    2023, 16(9):1482-1488. DOI: 10.18240/ijo.2023.09.15
    [Abstract](124) [HTML](0) [PDF 3.81 M](636)
    Abstract:
    AIM: To investigate the aqueous vein in vivo by using enhanced depth imaging optical coherence tomography (EDI-OCT) and optical coherence tomography angiography (OCTA). METHODS: In this cross-sectional comparative study, 30 healthy participants were enrolled. Images of the aqueous and conjunctival veins were captured by EDI-OCT and OCTA before and after water loading. The area, height, width, location depth and blood flow of the aqueous vein and conjunctival vein were measured by Image J software. RESULTS: In the static state, the area of the aqueous vein was 8166.7±3272.7 μm2, which was smaller than that of the conjunctival vein (13 690±7457 μm2, P<0.001). The mean blood flow density of the aqueous vein was 35.3%±12.6%, which was significantly less than that of the conjunctival vein (51.5%±10.6%, P<0.001). After water loading, the area of the aqueous vein decreased significantly from 8725.8±779.4 μm2 (baseline) to 7005.2±566.2 μm2 at 45min but rose to 7863.0±703.2 μm2 at 60min (P=0.032). The blood flow density of the aqueous vein decreased significantly from 41.2%±4.5% (baseline) to 35.4%±3.2% at 30min but returned to 45.6%±3.6% at 60min (P=0.021). CONCLUSION: The structure and blood flow density of the aqueous vein can be effectively evaluated by OCT and OCTA. These may become biological indicators to evaluate aqueous vein changes and aqueous outflow resistance under different interventions in glaucoma patients.
    16  Clinical efficacy and changes of serum VEGF-A, VEGF-B, and PLGF after conbercept treating neovascular age-related macular degeneration
    Xiao-Dong Chen ,  Chan Li ,  Guo-Long Ding ,  Yan Suo ,  Yu-Sheng Zhu ,  Hui-Qin Lu
    2023, 16(9):1489-1495. DOI: 10.18240/ijo.2023.09.16
    [Abstract](157) [HTML](0) [PDF 1.50 M](613)
    Abstract:
    AIM: To evaluate the clinical efficacy and systemic safety profile of conbercept in clinical practice on vascular endothelial growth factor (VEGF)-A, VEGF-B, and placental growth factor (PLGF) levels after intravitreal injections for the neovascular age-related macular degeneration (AMD). METHODS: Thirty-five patients (35 eyes) with neovascular AMD received intravitreal injections of conbercept treatment with pro re nata protocol. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were detected before the intravitreal injection and at 1, 3, and 12mo after conbercept treatment. The levels of serum VEGF-A, VEGF-B, and PLGF were measured by enzyme-linked immunosorbent assay before the injection and 1 and 12mo after conbercept treatments. RESULTS: At baseline, the mean BCVA score was 39.89±14.64 letters. The mean BCVA scores were 51.03±15.78, 56.71±14.38, and 52.49±10.16 letters at 1, 3, and 12mo after conbercept treatment, and the BCVA improvements were all significant, respectively (P<0.05). At baseline, the mean CRT was 436.7±141.9 µm. At 1, 3, and 12mo after conbercept treatment, the mean CRT values were 335.1±147.8, 301.1±116.5, and 312.2±98.22 µm, and the CRT improvements were all significant, respectively (P<0.05). At baseline, 1 and 12mo after conbercept treatment, the mean levels of serum VEGF-A were 1013.8±454.3, 953.1±426.4, and 981.5±471.7 pg/mL, the mean levels of serum VEGF-B were 46.93±24.76, 42.99±19.16, and 45.32±18.76 pg/mL, the mean levels of serum PLGF at these points were 251.7±154.9, 241.3±166.7, and 245.6±147.2 pg/mL, respectively. Compared with the baseline, the levels of serum VEGF-A, VEGF-B, and PLGF did not significantly change at 1 and 12mo after conbercept treatment, respectively (P>0.05). CONCLUSION: Conbercept intravitreal injection leads to BCVA and CRT improvement, however, it does not significantly affect systemic serum VEGF-A, VEGF-B, and PLGF levels at 1 and 12mo after intravitreal injection treating neovascular AMD.
    17  One-year outcomes of resveratrol supplement with aflibercept versus aflibercept monotherapy in wet age-related macular degeneration
    Ioannis Datseris ,  Nikolaos Bouratzis ,  Charalambos Kotronis ,  Iordanis Datseris ,  Malvina-Efthimia Tzanidaki ,  Alexandros Rouvas ,  Nikolaos Gouliopoulos
    2023, 16(9):1496-1502. DOI: 10.18240/ijo.2023.09.17
    [Abstract](194) [HTML](0) [PDF 786.29 K](646)
    Abstract:
    AIM: To determine the one-year outcomes of resveratrol oral supplement in patients suffering from wet age-related macular degeneration (AMD). METHODS: Fifty naïve and previously untreated patients suffering from wet AMD, were randomly assigned in two subgroups of 25 patients each. All the participants were treated with 3 monthly intravitreal injections of 2.0 mg aflibercept (IAIs) followed by injections “according to need”, while in one group the patients also received daily two tablets of resveratrol oral supplement. Prior to treatment initiation, a complete ophthalmological examination, including best corrected visual acuity (BCVA) and contrast sensitivity evaluation, optical coherence tomography (OCT) scans, fundus autofluorescence (FAF), fluorescein angiography, indocyanine green angiography, and OCT angiography (OCTA), was performed to every participant, while all of them completed the Hospital Anxiety and Depression Scale (HADS) questionnaire, in order to assess their quality of life (QoL) status. The patients were assessed monthly for 1y with FAF, and OCT or OCTA; the main endpoints were the number IAIs, the changes in BCVA, in contrast sensitivity, and in patients' QoL status. RESULTS: No significant differences were present between the groups regarding the baseline demographic and clinical data. Over the 12-month period, a similar number of IAIs was applied in both groups (4.52±1.00 vs 4.28±0.90, P=0.38), while the rest of the clinical data also did not differ significantly after the completion of the study period. However, for HADS Depression (11.88±2.51 vs 8.28±1.54, P<0.001) and HADS Anxiety (11.92±2.52 vs 7.76±1.51, P<0.001) questionnaires values, the score was significantly better in patients who received resveratrol supplements. Moreover, a statistically significant difference was detected in the mean change from baseline values of contrast sensitivity (0.17±0.19 vs 0.35±0.24, P=0.005), HADS Depression (0.08±1.38 vs -3.88±1.48, P<0.001), and HADS Anxiety (0.36±1.98 vs -5.12±2.70, P<0.001) scores, in favour of the patients treated with resveratrol supplements. CONCLUSION: The resveratrol oral supplement is a complementary treatment in cases of wet AMD, highlighting its effectiveness in improving patients' QoL status.
    18  Epiretinal membrane related vascular changes in diabetic eyes evaluated with optical coherence tomography angiography
    Umay Guvenc ,  Guner Uney ,  Nurten Unlu ,  Mehmet Akif Acar ,  Dicle Hazırolan ,  Ozlem Candan
    2023, 16(9):1503-1511. DOI: 10.18240/ijo.2023.09.18
    [Abstract](133) [HTML](0) [PDF 3.41 M](666)
    Abstract:
    AIM: To evaluate the retinochoroidal microvascular circulation and anatomical structure of diabetic and non-diabetic patients with epiretinal membrane (ERM) with the help of optical coherence tomography angiography (OCT-A) and compare them with healthy control subjects. METHODS: In this prospective, cross-sectional study, a total of 165 eyes were evaluated, including 50 eyes of patients with diabetic ERM, 54 eyes of idiopathic ERM (iERM) patients, and 61 eyes of healthy controls. Macula and disc angiography was performed by OCT-A. Macular vessel density (VD) ratio was evaluated by dividing the VD of the foveal region by the VD of the parafoveal region. Statistical calculations were evaluated at the 95% confidence interval. RESULTS: Macula superficial VD values of ERM cases were lower than that in the control group, while foveal VD was higher in ERM cases. Macula deep VD values of ERM cases were lower in all quadrants, except the fovea. The width of the foveal avascular zone (FAZ) area was significantly lower in the ERM groups, and the FAZ width was lowest in iERM group. Macula superficial VD ratio was significantly higher in the ERM groups, but there was no significant difference between ERM groups. Macula deep VD ratio was significantly higher in the iERM group than in the control group. CONCLUSION: Diabetic and idiopathic ERMs differ in their mechanism of formation and clinical presentation, as well as their effect on retinal vascular structures. If the relationship of increase of retinal thickness with vascular integrity can be demonstrated with OCT-A, then, OCT-A can be used as a guide for ERM prognosis.
    19  Changes of retinal vessel density in low to moderate myopic eyes with orthokeratology evaluated by optical coherence tomography angiography
    Jia-Hui Shi ,  Yi-Ping Zhao ,  Gang Liu ,  Xin-Yi Huang ,  Li-Li Lang ,  Wan-Cheng Jia ,  Ji-Li Chen
    2023, 16(9):1512-1520. DOI: 10.18240/ijo.2023.09.19
    [Abstract](171) [HTML](0) [PDF 3.25 M](611)
    Abstract:
    AIM: To explore the effect of orthokeratology (OK) fitting on retinal vessel density in low to moderate myopia adolescents by using optical coherence tomography angiography. METHODS: Children aged 10 to 14y with a cycloplegic spherical equivalent refraction of −0.50 diopter (D) to −5.00 D and astigmatism with more than −1.50 D were recruited. The enrolled adolescents were divided into OK group and spectacle group. During regular follow-up, adolescents were measured respectively at pre-wear, 1, 3, and 6mo after treatment. The follow-up included uncorrected distance visual acuity (UDVA), axial length (AL), superficial capillary plexus density (SCPD), deep capillary plexus density (DCPD), central retinal thickness (CRT), foveal avascular zone area (FAZ-A), foveal avascular zone perimeter (FAZ-P) and foveal vessel density in a 300-µm-wide region around foveal avascular zone (FD-300). The collected data were analyzed using statistical methods. RESULTS: By one month, SCPD significantly increased in the fovea and superior retina, and DCPD significantly increased inferiorly in OK group compared to spectacle group (P<0.05). By three months, there were significant increases in SCPD in the fovea and inferior retina, and DCPD in the parafovea, superior, and inferior retina in OK group (P<0.05), while the increase in SCPD and DCPD in the fovea were observed by six months (P<0.05). The FD-300 significantly increased at every follow-up in OK group compared to spectacle group (P<0.05). No significant differences in the CRT, FAZ-A and FAZ-P and FD-300 were observed between two groups (P>0.05). OK group showed a significant improvement in UDVA after wearing OK, compared to spectacle group (P<0.01), while the AL did not show a significant difference between two groups (P>0.05). CONCLUSION: Short-term OK worn can increase local retinal vessel density in adolescents with low-to-moderate myopia.
    20  Retrolaminar migration as a complication of intraocular silicone oil injection detected on unenhanced CT
    Fan-Fan Zhao ,  Ya-Ling Pan ,  Hui Jin ,  Yang-Yang Wu ,  Yu-Ting Yan ,  Yu Meng ,  Xiang-Yang Gong
    2023, 16(9):1521-1526. DOI: 10.18240/ijo.2023.09.20
    [Abstract](127) [HTML](0) [PDF 1.93 M](497)
    Abstract:
    AIM: To describe the clinical and radiologic features of retrolaminar migration silicone oil (SiO) and observe the dynamic position of ventricular oil accumulation in supine and prone. METHODS: For this retrospective study, 29 patients who had a history of SiO injection treatment and underwent unenhanced head computed tomography (CT) were included from January 2019 to October 2022. The patients were divided into migration-positive and negative groups. Clinical history and CT features were compared using Whitney U and Fisher's exact tests. The dynamic position of SiO was observed within the ventricular system in supine and prone. CT images were visually assessed for SiO migration along the retrolaminar involving pathways for vision (optic nerve, chiasm, and tract) and ventricular system. RESULTS: Intraocular SiO migration was found in 5 of the 29 patients (17.24%), with SiO at the optic nerve head (n=1), optic nerve (n=4), optic chiasm (n=1), optic tract (n=1), and within lateral ventricles (n=1). The time interval between SiO injection and CT examination of migration-positive cases was significantly higher than that of migration-negative patients (22.8±16.5mo vs 13.1±2.6mo, P<0.001). The hyperdense lesion located in the frontal horns of the right lateral ventricle migrated to the fourth ventricle when changing the position from supine to prone. CONCLUSION: Although SiO retrolaminar migration is unusual, the clinician and radiologist should be aware of migration routes. The supine combined with prone examination is the first-choice method to confirm the presence of SiO in the ventricular system.
    21  Time trends and gender disparities of Chinese cataract burden and their predictions
    Tian-Hong Wu ,  Bo Jiang ,  Wei-Ming Liu ,  Jian-Qing Li ,  Zi-Yue Song ,  Pei-Rong Lu
    2023, 16(9):1527-1534. DOI: 10.18240/ijo.2023.09.21
    [Abstract](175) [HTML](0) [PDF 2.16 M](933)
    Abstract:
    AIM: To evaluate the trends and changes in the number and rates of disability-adjusted life years (DALYs) and prevalence of cataract in China between 1990 and 2019, and to predict the trends of cataract burden from 2020 to 2030. METHODS: The Global Burden of Diseases (GBD) database was employed to collect the data on DALYs and the prevalence of cataract in China, which was distinguished by age and sex during the past three decades from 1990 to 2019, and then changes in the number and rates of cataract from 2020 to 2030 were predicted. All data were analyzed by the R program (version 4.2.2) and GraphPad Prism 9.0 statistics software. RESULTS: The number of DALYs of cataract increased from 449 322.84 in 1990 to 1 087 987.61 in 2019, number of cataract cases increased from 5 607 600.94 in 1990 to 18 142 568.96 in 2019. The age-standardized DALY rates (ASDR) generally increased slightly [estimated annual percentage change (EAPC=0.1; 95%CI: -0.24 to 0.45), age-standardized prevalence rates (ASPR) also increased (EAPC=0.88; 95%CI: 0.6 to 1.15). Cataract burden increased with age and female gender. Among the causes of cataract, air pollution was the most important, followed by smoking, high fasting plasma glucose, and high body mass index (BMI). The burden of cataract is predicted to grow persistently from 2020 to 2030, the number of DALYs and prevalence for cataract will rise to 2 336 431 and 43 698 620 respectively by 2030, the ASDR is predicted to be 85/100 000 and ASPR will be 1586/100 000 in 2030, females will still be at greater risk of suffering from cataract than males. CONCLUSION: The burden of cataract in China kept rising from 1990 to 2019. Increasing age and female gender are risk factors for cataract. Air pollution, smoking, high fasting plasma glucose, and high BMI are associated with cataract. The burden of cataract in China will gradually increase from 2020 to 2030, the elderly women in particular need attention. Our results may be of help for providing reference strategies to reduce cataract burden in the near future.
    22  The prevalence of red-green color vision deficiency and its related factors in an elderly population above 60 years of age
    Hassan Hashemi ,  Aida Shahidi ,  Alireza Hashemi ,  Alireza Jamali ,  Abolghasem Mortazavi ,  Mehdi Khabazkhoob
    2023, 16(9):1535-1541. DOI: 10.18240/ijo.2023.09.22
    [Abstract](144) [HTML](0) [PDF 4.08 M](673)
    Abstract:
    AIM: To determine the prevalence of red-green (RG) color vision deficiency (CVD) in an elderly population and its related factors. METHODS: This report is a part of the Tehran Geriatric Eye Study: a cross-sectional population-based study that was conducted on the elderly population (≥60y) of Tehran, Iran using multi-stage stratified random cluster sampling. All study participants underwent complete ocular examination, including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, and slit-lamp biomicroscopy. The color vision was tested using Ishihara plates with the near optical correction in place. RESULTS: Of the 3791 invitees, 3310 participated in the study. The data of 2164 individuals were analyzed after applying the exclusion criteria. The prevalence of R-G CVD was 3.73% (95%CI: 2.37%–5.09%) in the whole sample; the prevalence of protanomaly, protanopia, and deuteranopia was 1.51%, 1.76%, and 0.45%, respectively. The prevalence of R-G CVD was significantly higher in males than in females. The prevalence of RG CVD increased with advancing age from 2.91% in the age group 60–64y to 5.8% in the age group ≥80y (P=0.070). According to the multiple logistic regression model, male sex, and glaucoma were significantly related to RG CVD. Older age and hypertension also had a marginally significant relationship with RG CVD. CONCLUSION: Changes in color vision occur in the elderly due to the aging process and some physiological and pathological factors. Since the change in visual perception may affect the person's performance, this aspect of the visual system's function should also be taken into consideration in the examinations of the elderly.
    23  Prevalence of color vision deficiency among Chinese college students and their quality of life
    Jing-Ge Gao ,  Mei Tian
    2023, 16(9):1542-1548. DOI: 10.18240/ijo.2023.09.23
    [Abstract](155) [HTML](0) [PDF 653.18 K](538)
    Abstract:
    AIM: To investigate the prevalence of color vision deficiency (CVD) among college students and their quality of life (QoL) in a Chinese college. METHODS: This cross-sectional study was performed in Sichuan University in Chengdu, China. The questionnaire containing participants' demographic data, as well as CVD related QoL was distributed to students who were screened as CVD [by Color Vision Examination Plates (Version 6)] in 2022 freshman entrance examination. Color blindness QoL (CBQoL) and utility analysis were used to evaluate the QoL of CVD students. RESULTS: There were 381 of 17 303 (2.20%) students screened as CVD, including 368 (4.11%) males and 13 (0.16%) females. A total of 317 students completed the questionnaire, the response rate was 83.20%. Only 166 participants (52.3%) knew they have CVD before the physical examination for college entrance examination, while a total of 145 participants (45.74%) hoped to be diagnosed earlier. The medians of CBQoL score and utility were 5.85 (range 2.2-6) and 1 (range 0-1), respectively. The proportions of students whose QoL is affected by CVD were 67.63% (211/312) and 42.27% (134/317) measured by CBQoL and utility analysis respectively. CONCLUSION: The prevalence of CVD in males is much higher than that in females. The time when CVD students first became aware of their CVD is relatively late. The QoL of the study population is quite high, while a large proportion of students' QoL are affected by CVD. It is suggested that as a congenital defect, CVD screening in China should be earlier, and appropriate guidance and support are needed for CVD patients to help them better adapt to life, study, and work.
    24  Simultaneous tectonic Descemet stripping endothelial keratoplasty and tectonic Bowman layer transplant for the management of corneal perforation
    Abdo Karim Tourkmani ,  Colm McAlinden ,  David F. Anderson ,  Jorge L. Alio del Barrio ,  Jorge L. Alió
    2023, 16(9):1549-1554. DOI: 10.18240/ijo.2023.09.24
    [Abstract](192) [HTML](0) [PDF 1018.80 K](574)
    Abstract:
    AIM: To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty (t-DSEK) and tectonic Bowman layer transplant (t-BLT) as an alternative to tectonic penetrating keratoplasty (t-PKP). METHODS: Three eyes of three patients receiving simultaneous t-DSEK and t-BLT for corneal perforation were included. The technique for DSEK was modified depending on individual requirements. The t-BLT technique was standardised using an 8 mm graft and fixated with a running suture. Success was measured by the ability of this procedure to close a corneal perforation. RESULTS: All three cases achieved tectonic eye globe restoration and remained stable during the minimum 3-month observation period. Reinterventions were relatively common: 2 cases required amniotic membrane transplant for persistent epithelial defects. One case required DSEK rebubbling. One case developed angle closure glaucoma requiring surgical peripheral iridectomy. CONCLUSION: Simultaneous t-DSEK and t-BLT may be a useful strategy for the management of corneal perforation as an alternative management to t-PKP for selected cases.
    25  Recording the direct surgeon’s view with an operating microscopic view improves microscopic ophthalmic surgery training
    Masayuki Akimoto ,  Kosei Tomita ,  Miyo Yoshida ,  Yuki Hama
    2023, 16(9):1555-1558. DOI: 10.18240/ijo.2023.09.25
    [Abstract](229) [HTML](0) [PDF 1.20 M](497)
    Abstract:
    AIM: To establish a recording system with a direct view of the surgeon to supplement video recording under an operating microscope, which lacks information on the movement and position of the surgeon's hands, and to facilitate the reproduction of a skilled surgeon's technique by a surgeon in training. METHODS: A small camera was attached to the operating microscope with a custom adapter. Microscopic surgeon's view and direct surgeon's view through this new camera were recorded in the surgical recording system. Both movies were synchronized and analyzed how do surgeons handle the instruments. RESULTS: A small camera attached to the operating microscope allowed the surgeon's hands motion to be recorded without interfering with the surgeon's movements. Different surgeons used different methods to manipulate the ultrasound handpiece and the irrigation/aspiration device. Even in the simple paracentesis procedure, different surgeons used different methods. Surgeons-in-training were able to identify and improve their weaknesses by watching synchronized movies of their hand motions and microscopic view. CONCLUSION: Simultaneous recording the surgical field out of the operating microscopic view by a small camera set on the microscope is comprehensive and improves surgeons-in-training understanding and learning surgeries.
    26  Supporting suture combined scleral fixation of toric IOL implantation in traumatic aniridia, aphakia and corneal astigmatic eye: a case report
    Yan Shao ,  Rong Luan ,  Ju-Ping Liu ,  Bo-Jie Hu ,  Xiao-Rong Li
    2023, 16(9):1559-1560. DOI: 10.18240/ijo.2023.09.26
    [Abstract](320) [HTML](0) [PDF 878.52 K](554)
    Abstract:
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