Volume 17,Issue 12,2024 Table of Contents

1 Bilateral meibomian gland morphological alterations in unilateral herpes simplex keratitis based on artificial intelligence analysis

Xin-Xin Yu , Xue-Wen Chen , Qi Dai , Shuang-Qing Wu

2024, 17(12):2153-2157. DOI: 10.18240/ijo.2024.12.01

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Abstract:
AIM: To explore whether unilateral herpes simplex keratitis (HSK) can cause morphological changes of bilateral meibomian glands (MGs) based on artificial intelligence (AI) analytical system. METHODS: In the retrospective study, 29 patients with unilateral HSK and 29 participants matched in terms of age and sex were included as control group. Meibographic images of the upper eyelid using Keratograph 5M and assessed ocular surface parameters including tear meniscus height and tear break-up time. MG density and vagueness values were automatically analyzed and calculated using an AI analytical system. We compared the differences between the affected and the contralateral unaffected eyes in HSK patients, and the normal control eyes. We employed either the paired t-test or the Wilcoxon signed-rank test to compare significant difference between the affected and unaffected eyes in HSK patients or between the HSK group and control group. RESULTS: The MG density was 0.19±0.09 in the HSK-affected eye and 0.18±0.07 in contralateral unaffected eye, which had no significant difference (P=0.616). The MG density between the affected eye with HSK and the normal control group was statistically significant (P=0.028). There was a significant difference in MG density between the contralateral unaffected eye and the normal control group (P=0.012). However, no significant difference in vagueness value was observed between the eye with HSK and the control group or between HSK eye and contralateral eye. CONCLUSION: The MG density between the HSK-affected eye and the contralateral unaffected eye don’t significantly differ, whereas there is a significant decrease in the HSK group compared to that of the normal participants. Unilateral HSV keratitis may suffer from bilateral changes of MG morphology indicating bilateral dry eye. Therefore, the fellow eye of patients with unilateral HSK should be considered a potential case of MG dysfunction, necessitating early treatment for bilateral dry eye in the clinic.

2 Alkali burn injury model of meibomian gland dysfunction in mice

Yong Li , Ya-Qiong Yang , Yong Lin , Ke Yan , Yu-Fei Lyu , Zhao-Qiang Zhang , Cai-Hong Huang , Jiao-Yue Hu , Zu-Guo Liu

2024, 17(12):2158-2166. DOI: 10.18240/ijo.2024.12.02

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Abstract:
AIM: To establish a stable, short-time, low-cost and reliable murine model of meibomian gland dysfunction (MGD). METHODS: A filter paper sheet soaked in 1.0 mol/L sodium hydroxide (NaOH) solution was used to touch the eyelid margin of C57BL/6J mice for 10s to establish the model. The other eye was left untreated as a control group. Eyelid margin morphological changes and the meibomian glands (MGs) were observed by slit lamp microscopy on days 5 and 10 post-burn. Hematoxylin-eosin (HE) staining and Oil red O staining were adopted in detecting the changes in MGs morphology and lipid deposition. Real-time polymerase chain reaction, Western blot, immunofluorescence staining and immunohistochemical staining were used to detect interleukin (IL)-6, IL-1β, IL-18, tumor necroses factor (TNF)-α, interferon (IFN)-γ, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 4 (NOX4), 3-nitroturosine (3-NT), 4-hydroxynonenal (4-HNE) and cytokeratin 10 (K10) expression changes in MGs. RESULTS: MGs showed plugging of orifice, glandular deficiency, abnormal acinar morphology, ductal dilatation, and lipid deposition after alkali burn. The expressions of IL-6, IL-18, IL-1β, IFN-γ, and TNF-α indicators of inflammation and oxidative stress in MGs tissues were significantly increased. Abnormal keratinization increased in the MG duct. CONCLUSION: A murine model of MGD is established by alkali burn of the eyelid margin that matches the clinical presentation of MGD providing a stable, short-time, low-cost, and reliable MGD model. The new method suggests efficient avenues for future research.

3 Biocompatibility of light responsive materials prepared for accommodative intraocular lenses manufacturing

Chen-Zi Liu , Ming-Hao Sun , Wei Dai , Lan-Cao Hao , Si-Quan Zhu

2024, 17(12):2167-2176. DOI: 10.18240/ijo.2024.12.03

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AIM: To investigate the biocompatibility and bacterial adhesion properties of light responsive materials (LRM) and analyze the feasibility and biosafety of employing LRM in the preparation of accommodative intraocular lenses (AIOLs). METHODS: Employing fundamental experimental research techniques, LRM with human lens epithelial cells (hLECs) and human retinal pigment epithelium cells (ARPE-19 cells) were co-cultured. Commercially available intraocular lenses (IOLs) were used as controls to perform cell counting kit-8 (CCK-8), cell staining under varying light intensities, cell adhesion and bacterial adhesion experiments. RESULTS: LRM exhibited a stronger inhibitory effect on the proliferation of ARPE19 cells than commercially available IOLs when co-cultured with the undiluted extract for 96h (P<0.05). Under other culturing conditions, the effects on the proliferation of hLECs and ARPE-19 cells were not significantly different between the two materials. Under the influence of light irradiation at intensities of 200 and 300 mW/cm2, LRM demonstrated a markedly higher inhibitory effect on the survival of hLECs compared to commercially available IOLs (P<0.0001). They also showed a stronger suppressive effect on the survival rate of ARPE-19 cells, with significant differences observed at 200 mW/cm2 (P<0.001) and extremely significant differences at 300 mW/cm2 (P<0.0001). Additionally, compared to commercially available IOLs, LRM had a higher number of cells adhering to their surface (P<0.05), as well as a significantly greater number of adherent bacterium (P<0.0001). CONCLUSION: LRM, characterized by their excellent non-contact tunable deformability and low cytotoxicity to ocular tissues, show considerable potential for use in the fabrication of AIOLs. These materials demonstrate strong cell adhesion; however, during photothermal conversion processes involving shape deformation under various light intensities, the resultant temperature rise may harm surrounding cells. These factors suggest that while the material plays a positive role in reducing the incidence of posterior capsule opacification (PCO), it also poses potential risks for retinal damage. Additionally, the strong bacterial adhesion of these materials indicates an increased risk of endophthalmitis.

4 Modeling monocular form deprivation in rabbits using a simulated-cataract intraocular lens

Si-Yi Gu , Li-Ming Xu , Wei-Jie Sun , Li-Li Liang , Lei Lin , Han Zou , Jing-Yuan Xu , Yu Zheng , Yuan-Yuan Li , Yin-Ying Zhao , Ping-Jun Chang , Yun-E Zhao

2024, 17(12):2177-2184. DOI: 10.18240/ijo.2024.12.04

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AIM: To establish an animal model of form deprivation amblyopia based on a simulated cataract intraocular lens (IOLs). METHODS: Poly(dimethyl siloxane)-SiO2 thin films (PSF) with different degrees of opacity as IOL materials were prepared. The light transmission of the PSF-IOL was measured, and its in vitro biosafety was determined by cell counting kit (CCK)-8 assay using the HLEC-B3 cell line and ARPE-19 cell line. Subsequently, the in vivo safety was determined by implanting the PSF-IOL with 10% wt SiO2 into the right eyes of New Zealand white rabbits (PSF-IOL group), and compared with two control groups: contralateral comparison group and normal control (NC) group (Contralateral comparison group: the fellow eye; NC group: a group of binocular normal rabbits without intervention). The flash visual-evoked potentials (F-VEPs) were measured to verify amblyopia. RESULTS: PSFs containing 0, 2%, and 10% wt SiO2 were successfully constructed. The 0 SiO2 PSF was transparent, while the 10% wt SiO2 PSF was completely opaque. It was found that PSF did not induce unwanted cytotoxicity in HLECs and ARPE19 cells in vitro. In vitro, PSF-IOL with 10% wt SiO2 was also non-toxic, and no significant inflammation or structural changes occurred after four weeks of PSF-IOL implantation. Finally, our IOL-simulated congenital cataract rabbit detected by F-VEPs suggested tentative amblyopia. CONCLUSION: A PSF-IOL that mimics cataracts is created. A novel form deprivation model is created by the IOL-simulated congenital cataract rabbit. It can be developed fast and stable and holds great potential for future study.

5 Analysis of SMOC2 gene variants in familial and non-familial primary open angle glaucoma Pakistani patients

Ashok Kumar Narsani , Feriha Fatima Khidri , Muhammad Rafiq , Jalpa Bai , Hina Shaikh , Yar Muhammad Waryah , Syed Habib Ahmed Naqvi , Preety Kumari , Mahesh Kumar Lohano , Ali Muhammad Waryah

2024, 17(12):2185-2191. DOI: 10.18240/ijo.2024.12.05

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AIM: To find out the association of secreted protein acidic and rich in cysteine (SPARC)-related modular calcium binding 2 (SMOC2) gene variants rs2255680 and rs13208776 with genotypic and phenotypic characteristics in both familial and non-familial primary open angle glaucoma (POAG) patients. METHODS: A total of 212 POAG patients, comprising 124 familial and 88 non-familial, were enrolled. For genotyping the SMOC2 variant rs2255680, amplification refractory mutation system (ARMS)-polymerase chain reaction (PCR) method and PCR-restriction fragment length polymorphism (PCR-RFLP) were utilized for analyzing rs13208776 variant. RESULTS: The mean age of familial POAG patients was 50.92±9.12y, with 78 males and 46 females. The mean age of non-familial POAG patients was 53.14±13.44y, with 52 males and 36 females. The SMOC2 gene variant rs13208776 showed the significant association with POAG between familial and non-familial groups. The homozygous G/G variant was frequent among non-familial (60.2%) whereas the heterozygous G/A variant was more frequent in familial POAG patients (46%). There were significant differences in G/A variant between familial and non-familial glaucoma patients, and the risk was decreased to 0.53-fold in non-familial glaucoma patients [odds ratio (OR): 0.53; 95% confidence interval (CI): 0.29-0.94; P=0.033] in codominant model. The risk was further reduced to 0.49-fold (95%CI: 0.28-0.86; P=0.012) in dominant model for non-familial patients. No significant association of SMOC2 gene variant rs2255680 between familial and non-familial glaucoma patients was found in our population. The haplotype analysis showed the decreased risk for TA [OR: 0.48 (95%CI: 0.29-0.79); P=0.004] and an increased risk for TG [OR=2.28 (95%CI: 1.22-4.25); P=0.01] haplotypes. CONCLUSION: Current findings show significant association of SMOC2 gene variant rs13208776 with POAG between familial and non-familial Pakistani patients.

6 Morphological and functional observations of a novel model of retinal ischemia injury induced by bilateral carotid artery stenosis in mice

Lian Shu , You-Jia Zhang , Xiao-Xiao Chen , Xing-Huai Sun

2024, 17(12):2192-2202. DOI: 10.18240/ijo.2024.12.06

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AIM: To investigate the features of retinal ischemic injuries in a novel mouse model with bilateral carotid artery stenosis (BCAS). METHODS: BCAS was induced with microcoil implantation in 6-8-week-old C57BL6 mice. Cerebral blood flow was monitored at 2, 7, and 28d postoperatively. Retinal morphological changes were evaluated by fundus photography and hematoxylin-eosin staining. Fluorescein fundus angiography (FFA) was performed to detect retinal vascular changes and circulation. The levels of apoptosis, activation of neurogliosis, and expression of hypoxia-inducible factor (HIF)-1α in the retina were assessed by Western blotting and immunofluorescence staining, followed by retinal ganglion cell (RGC) density detection. Additionally, electrophysiological examinations including photopic negative response (PhNR) was also performed. RESULTS: The mice demonstrated an initial rapid decrease in cerebral blood flow, followed by a 4-week recovery period after BCAS. The ratio of retinal artery and vein was decreased under fundus photography and FFA. Compared with the sham mice, BCAS mice showed thinner retinal thickness on day 28. Additionally, apoptosis was increased and RGC density was decreased mainly in peripheral retinal region. Neurogliosis was mainly located in the inner retinal layers, with a stable increase in HIF-1α expression. The dark-adapted electroretinogram showed a notable reduction in the a-, b-, and oscillatory potential (OP) wave amplitudes between days 2 and 7; this gradually recovered over the following 4wk. However, the b- and OP-wave amplitudes were still significantly decreased on PhNR examination on day 28. CONCLUSION: BCAS can result in relatively mild retinal ischemia injuries in mice, mainly in the inner layer and peripheral region. Our study provides a novel animal model for investigating retinal ischemic diseases.

7 Guidelines for the standardized diagnosis and treatment of non-specific orbital inflammation (2024)

Yi Shao , Jian-Min Ma , Hua-Sheng Yang , Expert Workgroup of Guidelines for Diagnosis , Treatment of Nonspecific Orbital Inflammation () , Ophthalmic Imaging , Intelligent Medicine Branch Chinese Medicine Education Association , Ocular Oncology Committee of the Ophthalmology Branch of the Chinese Medical Doctor Association , Ophthalmology Committee of International Association of Translational Medicine , Ophthalmology Committee of International Association of Intelligent Medicine , Chinese Ophthalmic Imaging Study Groups

2024, 17(12):2203-2213. DOI: 10.18240/ijo.2024.12.07

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Non-specific orbital inflammation (NSOI) is a non-infectious orbital inflammation. Although it is often considered the most common diagnosis in orbital biopsies, it is an exclusionary diagnosis that requires ruling out systemic disease or other possible causes. Its characteristics include acute orbital signs and symptoms, including pain, proptosis, periorbital edema, chemosis, diplopia, and visual impairment. The clinical manifestations and histological findings of NSOI are heterogeneous, without specific diagnostic criteria or treatment guidelines, which poses significant challenges for diagnosis and treatment. This guideline provides a detailed description of the definition, classification, diagnosis, and treatment of NSOI.

8 Influencing factors of ocular pain in dry eye disease patients at high altitude

Peng-Cheng Zhang , Wen-Shan Jiang , Ya-Zhen Wu , Han-Jing Dai , Dan Wang , Yu-Meng Bao , Hong Yan

2024, 17(12):2214-2220. DOI: 10.18240/ijo.2024.12.08

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AIM: To quantify the severity and frequency of ocular pain in Tibetan plateau patients with dry eye, and to evaluate the related factors affecting ocular pain. METHODS: A retrospective study included 160 cases of dry eye disease (DED) patients who were treated from July 2022 to June 2023. Age, gender, occupation, illness course, anxiety, plateau duration, plateau protection, ocular surface disease index scale (OSDI), break-up time (BUT), Schirmer I test (SIT), conjunctivitis, history of ophthalmic medication, autoimmune disease, the workload of daily near vision range, smoking and overnight stay were obtained via comprehensive ophthalmic assessment, and their duration was followed up. Logistic regression analysis was used to determine the related factors affecting ocular pain. RESULTS: Totally 77.5% (124/160) of DED patients had ocular pain, of which the severity of ocular pain was mild, moderate, and severe in 30.0%, 36.3%, and 11.3% of patients, respectively. Frequency of ocular pain was reported occasional, half the time, frequent, and persistent pain in 19.4%, 36.9%, 16.9%, and 4.4%. OSDI score was 19.67±5.70 (13 to 36), and the level of pain was lowly correlated with OSDI (rs=0.316, P<0.001). Logistic regression showed that in plateau DED patients, increased anxiety led to increased severity and frequency of ocular pain [odds ratio (OR)=3.662, 5.613, 2.387, and 4.870; all P<0.05], professional eye protection and improvement of daily sleep quantity decreased pain (OR=0.307, 0.572, 0.418, and 0.789; all P<0.05), while smoking and general protection of plateau did not affect the severity and frequency of ocular pain (all P>0.05). CONCLUSION: Ocular pain is a common complaint in high-altitude DED patients during the pandemic. Anxiety, eye protection, and adequate sleep during the epidemic period are significantly associated with the severity and frequency of ocular pain in patients with plateau DED, while symptoms of DED have relatively little influence on them.

9 Treatment of superficial corneal opacities with corneal stromal lenticule obtained through SMILE surgery

Shi-Si Hu , Hui Ding , Xu-Yun Meng , Bo-Wen Ouyang , Zhen-Duo Yang , Xiao-Dan Chen , Xing-Wu Zhong

2024, 17(12):2221-2228. DOI: 10.18240/ijo.2024.12.09

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AIM: To evaluate the clinical efficacy and feasibility of superficial corneal opacities treated by excimer laser phototherapeutic keratectomy (PTK) combined with small incision lenticule extraction (SMILE)-derived corneal stromal lenticule transplantation. METHODS: A retrospective interventional case series of nine patients aged 12–59y with superficial corneal opacity caused by different pathologies who underwent standardized PTK combined with SMILE-derived corneal stromal lenticule transplantation was examined. Lenticule patches were fixed with fibrin glue. All patients underwent pre- and post-operative clinical assessments at different times for up to 12mo. Slit lamp microscopy, corneal density, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and anterior segment optical coherence tomography (AS-OCT) were examined. RESULTS: The patients’ mean age was 36.00±5.80 (12–59)y. Seven eyes (77.8%) gained UDVA and CDVA at the last measurement compared to their preoperative levels. The densities of the total cornea, the total anterior corneal layer, and the anterior corneal layers of 0–2 and 2–6 mm decreased significantly by 12.4%, 27.5%, 46.7%, and 32.8%, respectively. After human allogeneic transplantation, the implanted lenticules of all eyes were clearly visible by AS-OCT and remained transparent without displacement or graft rejection. The thickness of the central cornea and corneal lenticule transplants were stable throughout the entire postoperative period. One case experienced the postoperative complication of delayed corneal epithelial healing. CONCLUSION: PTK combined with SMILE-derived corneal lenticule transplantation improves long-term visual acuity. Therefore, it is a new, safe, and effective method for treating superficial corneal opacity.

10 Efficacy of mycophenolate mofetil combined with topical 0.05% tacrolimus in high-risk keratoplasty: 1-year cohort study

Jin-Yu Zhang , Kang Yu , Xiu-Ying Jiang , Jia-Xin Liang , Shi-You Zhou

2024, 17(12):2229-2235. DOI: 10.18240/ijo.2024.12.10

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AIM: To investigate the efficacy of systemic mycophenolate mofetil (MMF) as an adjunct in combination with topical tacrolimus (FK506) and corticosteroid eyedrops for preventing corneal graft rejection after high-risk keratoplasty (HRK). METHODS: In this cohort study, 55 consecutive patients (55 eyes) from an eye center who met the criteria of HRK were included. The definition for HRK includes large grafts of no less than 9 mm diameter, vascularized cornea of two or more quadrants, regrafting, or eccentric grafts. After penetrating keratoplasty, 25 patients treated with systemic MMF in combination with 0.05% FK506 and tapering corticosteroid eyedrops were enrolled in Group 1 from October 2019. Thirty patients receiving postoperative treatment with 0.05% FK506 and tapering corticosteroid eyedrops alone were enrolled in Group 2 from January 2018 to September 2019. All participants were closely monitored after surgery, and episodes of graft rejection and relevant clinical data were collected and assessed over a one-year follow-up period. RESULTS: After a follow-up of 9.6±3.2mo, graft rejection episodes occurred in 4 cases (16%) in Group 1 and 18 cases (60%) in Group 2. One reversible and 3 irreversible graft rejections occurred in Group 1, while 3 reversible and 15 irreversible rejections occurred in Group 2. Kaplan–Meier analysis revealed that 82.5% of grafts in Group 1 and 37.1% in Group 2 did not experience corneal graft rejection (P<0.01, log-rank test). The clear graft survival rate was 83.6% in Group 1 and 36.7% in Group 2 (P<0.01, log-rank test) within one year of follow-up. No severe systemic side effects were observed in either group during the follow-up period. CONCLUSION: The triple treatment regimen consisting of MMF, topical FK506, and corticosteroid eyedrops represents a promising strategy for effectively preventing graft rejection and improving graft survival in patients with HRK.

11 Refraction difference value variations in children and adolescents with different refractive errors

Da-Wen Wu , Ze-Yi Yang , Yan Nie , He-Ya Ye , Liang Chen , Long-Qian Liu , Guo-Yuan Yang

2024, 17(12):2236-2242. DOI: 10.18240/ijo.2024.12.11

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AIM: To evaluate the refraction difference value (RDV) variations in children and adolescents with different refractive errors and analyze its correlation with refractive development. METHODS: Participants aged 4-16y with different refractive statuses (hyperopia, emmetropia, myopia) underwent comprehensive eye examinations, including spherical equivalent (SE) refraction, axial length (AL), total RDV (TRDV), and RDVs at various eccentricities (0°-15°, 15°-30°, 30°-45°) and quadrants (inferior, superior, nasal, temporal). Statistical analysis involved one-way ANOVA for group comparisons and Pearson correlation for examining relationships between SE/AL and RDVs. Paired t-tests compared quadrant-specific RDVs within groups. RESULTS: Significant difference was found in TRDV (P<0.001), RDV15°-30° (P=0.033), RDV30°-45° (P<0.001), RDV-inferior (RDV-I, P<0.001) and RDV-temporal (RDV-T, P<0.001) among hyperopia, emmetropia and myopia group. Pearson correlation analysis revealed a negative correlation of SE with TRDV (P=0.001), RDV30°-45° (P=0.004), RDV-I (P=0.047), and RDV-T (P<0.001). The differences between RDV-superior (RDV-S) and RDV-I were statistically significant in all groups (P<0.001 for all) and between RDV-T and RDV-nasal (RDV-N) were statistically significant in hyperopia group (P<0.001). Within the pre-myopic group, the analysis revealed a negative correlation of SE with RDV-I (P=0.009). Pearson correlation analysis revealed a positive correlation of AL with TRDV (P=0.036), RDV15°-30° (P=0.004), RDV30°-45° (P<0.001), RDV-S (P=0.003), RDV-I (P<0.001), RDV-T (P<0.001), RDV-N (P=0.022), while revealed a negative correlation of AL with RDV0-15° (P=0.018). CONCLUSION: Our study indicates TRDV, RDV30°-45°, RDV-I, RDV-T may relate to refractive development, and a negative correlation between SE and RDV-I in pre-myopic children.

12 Effect of astigmatism and spherical equivalent correction on contrast sensitivity

Maryam Saffarizadeh , Saeed Rahmani , Alireza Akbarzadeh Baghban , Mohammad Ghassemi-Broumand

2024, 17(12):2243-2247. DOI: 10.18240/ijo.2024.12.12

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AIM: To investigate the effect of astigmatism and spherical equivalent (SE) correction on contrast sensitivity (CS). METHODS: In this cross-sectional study, 103 visually normal subjects aged 18 to 36y with bilateral regular astigmatism in range of 1.00 diopter cylinder (DC) to 4.00 DC and normal best-corrected visual acuity (20/20) were recruited. Binocular CS was assessed by linear sine-wave gratings at 1.5, 3, 6, 12, and 18 cycles per degree (cpd), before correction of astigmatism, after full correction of astigmatism by cylindrical spectacle lenses, and after SE of refractive error. The repeated measures ANOVA and Bonferroni test were used to compare the effects of astigmatism correction on logCS. RESULTS: Totally 39 patients were male and 64 patients were female with the mean age of 28.25±5.38y. The average degree of astigmatism in right and left eye was 2.03±0.83 and 2.10±0.78, respectively. Increases in uncorrected astigmatic power correlated with decreases in the logCS, especially at high spatial frequencies. A statistically significant difference in logCS was found between these three cases: before correction of astigmatism, after SE of refractive error, and after full correction of astigmatism by cylindrical spectacle lenses at all frequencies (P<0.001), except at 18 cpd. At 18 cpd, there was no statistically significant difference between logCS before and after SE of refractive error (P=1.0). Also, there was no statistically significant difference in mean CS between with-the-rule (WTR) and against-the-rule (ATR) astigmatism, before correction of astigmatism, after correction of astigmatism with cylindrical lenses, and after SE of refractive error. CONCLUSION: Binocular astigmatism defocus decreases CS depending on the degree of astigmatism power; correction of this will improve patent’s quality of vision. Although high astigmatism refractive error (more than 2.00 DC) that is fully corrected by cylindrical spectacle lenses doesn’t increase the CS to the maximum value, especially at higher spatial frequencies (12 and 18). Also SE refractive error effects on improving CS in low astigmatism power (less than 2.00 DC), especially at lower spatial frequencies.

13 Functional connectivity of paired default mode network subregions in patients with eye trauma

Zheng-Mao Xing , Dan Song , Jin-Yu Hu , Xian-Mei Zhou , Xuan Liao , Cheng Chen , Hong Wei , Min Kang , Qian Ling , Liang-Qi He , Zhen-Zhe Liu , Jie Zou , Xu Chen , Zhen-Kai Wu , Yi Shao

2024, 17(12):2248-2255. DOI: 10.18240/ijo.2024.12.13

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AIM: To study functional brain abnormalities in patients with eye trauma (ET) and to discuss the pathophysiological mechanisms of ET. METHODS: Totally 31 ET patients and 31 healthy controls (HCs) were recruited. The age, gender, and educational background characteristics of the two groups were similar. After functional magnetic resonance imaging (fMRI) scanning, the subjects’ spontaneous brain activity was evaluated with the functional connectivity (FC) method. Receiver operating characteristic (ROC) curve analysis was used to classify the data. Pearson’s correlation analysis was used to explore the relationship between FC values in specific brain regions and clinical behaviors in patients with ET. RESULTS: Significantly increased FC between several regions was identified including the medial prefrontal cortex (MPFC) and left hippocampus formations (HF), the MPFC and left inferior parietal lobule (IPL), the left IPL and left medial temporal lobe (MTL), the left IPL and right MTL, and the right IPL and left MTL. No decreased region-to-region connectivity was detected in default mode network (DMN) sub-regions in patients with ET. Compared with HCs, ET patients exhibited significantly increased FC between several paired DMN regions, as follows: posterior cingulate cortex (PCC) and right HF (HF.R, t=2.196, P=0.032), right inferior parietal cortices (IPC.R) and left MTL (MTL.L, t=2.243, P=0.029), and right MTL (MTL.R) and HF.R (t=2.236, P=0.029). CONCLUSION: FC values in multiple brain regions of ET patients are abnormal, suggesting that these brain regions in ET patients may be dysfunctional, which may help to reveal the pathophysiological mechanisms of ET.

14 Endoscopy-assisted vitrectomy for severe ocular penetrating trauma with corneal opacity

Yong-Zhen Yu , Liu-Lian Jian , Wen-Xiao Chen , Liang-Hong Peng , Yu-Ping Zou , Long Pang , Xiu-Lan Zou

2024, 17(12):2256-2264. DOI: 10.18240/ijo.2024.12.14

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AIM: To assess the utility and efficiency of endoscopy-assisted vitrectomy (EAV) for the treatment of corneal opacity in severe ocular trauma. METHODS: Patients who underwent fundus examination using a preoperative slit lamp and intraoperative endoscopy, followed by EAV and additional surgery were retrospectively recruited. Silicone oil removal and penetrating keratoplasty were used in selected eyes at postoperative follow-ups. Outcome measurements included the best corrected visual acuity (BCVA), intraocular pressure (IOP), findings of endoscopic fundus examination, and postoperative complications. RESULTS: Twenty-one eyes with severe ocular trauma and corneal opacity were followed up for 24–36mo. Retinal detachment (RD) and vitreous haemorrhage (VH) were identified in 16 eyes (76.2%), RD only in four eyes (19.0%), and VH combined with intraocular foreign body in one eye (4.8%). All eyes underwent at least three surgeries. Stage-I surgeries involved wound closure (100%), lens extraction (76.2%), and anterior vitrectomy (14.3%). Stage-II surgeries involved scleral buckling (28.6%), membrane peeling (47.6%), retinal laser photocoagulation (100%) and silicone oil tamponade (100%) using EAV. Stage-III surgeries were conducted using endoscopy including silicone oil removal (52.4%), retinal laser photocoagulation (52.4%) and penetrating keratoplasty (28.6%). Nearly all eyes showed improvements in BCVA and IOP. Although there were no severe complications, glaucoma was noted in one eye, chronic hypotony in another eye, and band keratopathy in three eyes. CONCLUSION: EAV is an effective adjunct for restoring ocular anatomical structures and visual function in the case of corneal opacity after severe ocular trauma.

15 Predictive value of CA-153, CA-125 and Apo A for ocular metastasis in menopausal female patients with breast cancer

Qun-Ce Liu , Qian Ling , Yan-Mei Zeng , Cheng Chen , Hong Wei , Jin-Yu Hu , Jie Zou , Xiao-Yu Wang , Xu Chen , Yi Shao

2024, 17(12):2265-2275. DOI: 10.18240/ijo.2024.12.15

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AIM: To establish a meaningful standard for diagnosing ocular metastasis (OM) in menopausal breast cancer (BC) women, and explore the relationship between CA-153, CA-125, apolipoprotein A, and OM. METHODS: A total of 1362 menopausal female BC patients with OM volunteered to take part in this study between July 2012 and July 2022. Women with BC who are menopausal were found to have an OM incidence of 1.6%. Furthermore, CA-153, CA-125, and apolipoprotein A (Apo A) all contributed to OM in women with BC who are postmenopausal according to binary logistic regression. Receiver operating curve (ROC) analysis was used to assess the diagnostic value of OM in patients with BC. RESULTS: Both CA-153 and CA-153+CA-125 showed a higher sensitivity of 95.45%, whereas CA-153+Apo A illustrated the highest specificity of 99.02%. Moreover, CA-153 and CA-153+CA-125 had higher areas under the curve (AUC) of 0.973. CONCLUSION: The data indicate that the serum concentrations of CA-153 exhibited the most significant predictors of the diagnosis of OM in menopausal women with BC. The current study researches the utility of risk factors in predicting of OM in menopausal BC women and put forward the latest suggestions on their clinical application.

16 Monocyte to high-density lipoprotein cholesterol ratio as a predictor of the activity of thyroid-associated ophthalmopathy

Xing-Hong Sun , Xiao-Wen Zhang , Chen Han , Xin Dou , Xue-Ying He , Meng-Ru Su , Feng Jiang , Song-Tao Yuan

2024, 17(12):2276-2281. DOI: 10.18240/ijo.2024.12.16

[Abstract](20) [HTML](0) [PDF 784.36 K](58)

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AIM: To evaluate the relationship between monocyte to high-density lipoprotein cholesterol ratio (MHR) and the disease activity of thyroid-associated ophthalmopathy (TAO). METHODS: A total of 87 patients were classified into two groups based on clinical activity score (CAS) scoring criteria: high CAS group (n=62, the CAS score was ≥3); low CAS group (n=25, the CAS score was <3). In addition, a group of healthy people (n=114) were included to compared the MHR. Proptosis, MHR, average signal intensity ratio (SIR), average lacrimal gland (LG)-SIR, average extraocular muscles (EOM) area from 87 patients with TAO were calculated in magnetic resonance imaging (MRI), and compared between these two groups. Correlation testing was utilized to evaluate the association of parameters among the clinical variables. RESULTS: Patients in high CAS group had a higher proptosis (P=0.041) and MHR (P=0.048). Compared to the healthy group, the MHR in the TAO group was higher (P=0.001). Correlation testing declared that CAS score was strongly associated with proptosis and average SIR, and MHR was positively associated with CAS score, average SIR, and average LG-SIR. The area under the receiver operating characteristic curve (AUC) of MHR was 0.6755. CONCLUSION: MHR, a novel inflammatory biomarker, has a significant association with CAS score and MRI imaging (average SIR and LG-SIR) and it can be a new promising predictor during the active phase of TAO.

17 Resistant corneal ulcers in a tertiary care ophthalmic center in Egypt: 10 years epidemiological study

Mohammad M. Khater , Mohammad Hosny Nassef , Mohamed Sameh Elshorbagy

2024, 17(12):2282-2287. DOI: 10.18240/ijo.2024.12.17

[Abstract](18) [HTML](0) [PDF 566.19 K](58)

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AIM: To investigate the magnitude of problem caused by resistant corneal ulcers and its epidemiological characteristics. METHODS: Patients with corneal lesions were selected and carefully examined and cases with resistant corneal ulcers were further investigated and data were recorded using a specific data sheet designed in hospital. Then, collected data from patients were statistically analyzed. RESULTS: Totally 1939 cases were included in the study, including 816 fungal cases (42.1%) and 1123 (57.9%) non-fungal cases. Age of the participants ranged from 18 to 73y. Fungal cases were more common in middle age (35–55y). Men were more affected (53.5%) of cases included in the study. Keratomycosis affected more unskilled personnel (75.1%), large families with small houses (higher crowding index 73.9%), rural (64.5%) residence. Patients with sanitary water sources (34.8%) and waste disposal (24.4%) were less affected. CONCLUSION: Keratomycosis is more frequent in unskilled personnel, rural locations, outdoor water sources and insanitary waste disposal systems. Corneal trauma and contact lens are common risk factors.

18 Prevalence of refractive errors in school-aged and preadolescent children in Colombia

Diana Garcia-Lozada , Diana Valeria Rey-Rodríguez , Sara Viviana Angulo-Sánchez , Jenny Maritza Sánchez-Espinosa

2024, 17(12):2288-2294. DOI: 10.18240/ijo.2024.12.18

[Abstract](160) [HTML](0) [PDF 875.56 K](117)

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AIM: To describe the distribution of refractive errors by age and sex among schoolchildren in Soacha, Colombia. METHODS: This was an observational cross-sectional study conducted in five urban public schools in the municipality of Soacha. A total of 1161 school-aged and pre-adolescent children, aged 5-12y were examined during the school year 2021-2022. Examinations included visual acuity and static refraction. Spherical equivalent (SE) was analysed as follows: myopia SE≤-0.50 D and uncorrected visual acuity of 20/25 or worse; high myopia SE≤-6.00 D; hyperopia SE≥+1.00 D (≥7y) or SE≥+2.00 D (5-6y); significant hyperopia SE≥+3.00 D. Astigmatism was defined as a cylinder in at least one eye ≥1.00 D (≥7y) or ≥1.75 D (5-6y). If at least one eye was ametropic, children were classified according to the refractive error found. RESULTS: Of the 1139 schoolchildren included, 50.6% were male, 58.8% were aged between 5 and 9y, and 12.1% were already using optical correction. The most common refractive error was astigmatism (31.1%), followed by myopia (20.8%) and hyperopia (13.1%). There was no significant relationship between refractive error and sex. There was a significant increase in astigmatism (P<0.001) and myopia (P<0.0001) with age. CONCLUSION: Astigmatism is the most common refractive error in children in an urban area of Colombia. Emmetropia decreased and myopia increased with age.

19 Artificial intelligence applications in ophthalmic optical coherence tomography: a 12-year bibliometric analysis

Ruo-Yu Wang , Si-Yuan Zhu , Xin-Ya Hu , Li Sun , Shao-Chong Zhang , Wei-Hua Yang

2024, 17(12):2295-2307. DOI: 10.18240/ijo.2024.12.19

[Abstract](24) [HTML](0) [PDF 2.04 M](93)

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AIM: To explore the current application and research frontiers of global ophthalmic optical coherence tomography (OCT) imaging artificial intelligence (AI) research. METHODS: The citation data were downloaded from the Web of Science Core Collection database (WoSCC) to evaluate the articles in application of AI in ophthalmic OCT published from January 1, 2012 to December 31, 2023. This information was analyzed using CiteSpace 6.2.R2 Advanced software, and high-impact articles were analyzed. RESULTS: In general, 877 articles from 65 countries were studied and analyzed, of which 261 were published by the United States and 252 by China. The centrality of the United States is 0.33, the H index is 38, and the H index of two institutions in England reaches 20. Ophthalmology, computer science, and AI are the main disciplines involved. Hot keywords after 2018 include deep learning (DL), AI, macular degeneration, and automatic segmentation. CONCLUSION: The annual number of articles on AI applications in ophthalmic OCT has grown rapidly. The United States holds a prominent position. Institutions like the University of California System and the University of London are spearheading advancements. Initial researches centered on the automatic recognition and diagnosis of ocular diseases leveraging traditional machine learning (ML) technology and OCT images. Nowadays, the imaging process algorithm selection has shifted its focus towards DL. Concurrently, optical coherence tomography angiography (OCTA) and computer-aided diagnosis (CAD) have emerged as key areas of contemporary research.

20 Development and research status of intelligent ophthalmology in China

Di Gong , Wang-Ting Li , Xiao-Meng Li , Cheng Wan , Yong-Jin Zhou , Shu-Jun Wang , Jian-Tao Wang , Yan-Wu Xu , Shao-Chong Zhang , Wei-Hua Yang

2024, 17(12):2308-2315. DOI: 10.18240/ijo.2024.12.20

[Abstract](71) [HTML](0) [PDF 402.74 K](94)

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This paper analyzes the current status, technological developments, academic exchange platforms, and future challenges and solutions in the field of intelligent ophthalmology (IO) in China. In terms of technology, significant progress has been made in various areas, including diabetic retinopathy, fundus image analysis, quality assessment of medical artificial intelligence products, clinical research methods, technical evaluation, and industry standards. Researchers continually enhance the safety and standardization of IO technology by formulating a series of clinical application guidelines and standards. The establishment of domestic and international academic exchange platforms provides extensive collaboration opportunities for professionals in various fields, and various academic journals serve as publication platforms for IO research. However, challenges such as technological innovation, data privacy and security, lagging regulations, and talent shortages still pose obstacles to future development. To address these issues, future efforts should focus on strengthening technological research and development, regulatory framework construction, talent cultivation, and increasing patient awareness and acceptance of new technologies. By comprehensively addressing these challenges, IO in China is poised to further lead the industry’s development on a global scale, bringing more innovation and convenience to the field of ophthalmic healthcare.

21 Characteristics of corneal aberration in patients with bilateral keratoconus and unilateral corneal Vogt’s striae

Sheng-Sheng Wei , Yong Li , Zhi-Qing Wu , Jian-Guo Liu , Jing Du , Jing Li , Yao-Hua Zhang

2024, 17(12):2316-2320. DOI: 10.18240/ijo.2024.12.21

[Abstract](17) [HTML](0) [PDF 861.34 K](64)

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AIM: To assess the corneal high-order aberration (HOA) and its correlation with corneal morphological parameters in patients with bilateral keratoconus (KCN) and unilateral Vogt’s striae. METHODS: A total of 168 eyes of 84 patients with KCN, whose corneas had definite signs of unilateral Vogt’s striae, were enrolled. Corneal HOA and morphological parameters were measured using Pentacam HR. RESULTS: The corneal morphological parameters between KCN eyes with and without Vogt’s striae were evidently different (P<0.001). The 3rd coma 90°, 4th spherical aberration, 5th coma 90°, root-mean-square (RMS) (total), and RMS (HOA) in the front, back surfaces and total cornea in KCN eyes with Vogt’s striae were significantly higher than those in KCN eyes without Vogt’s striae (P<0.001). In KCN eyes with Vogt’s striae, the 3rd coma 90° and 4th spherical aberration in the front surface and total cornea were negatively correlated with flat keratometry value (K1), steep keratometry value (K2), mean keratometry value (Km), maximum keratometry value (Kmax), anterior corneal elevation (ACE), and posterior corneal elevation (PCE; P<0.05). The 3rd coma 90°, 4th spherical aberration in back surface and RMS (total), RMS (HOA) in the front, back surfaces, total cornea were positively correlated with K1, K2, Km, Kmax, ACE, and PCE (P<0.05). CONCLUSION: Corneal HOA especially vertical coma and spherical aberration may increase when Vogt’s striae appeared in KCN eyes. The scale of increase is significantly related with changes in corneal shapes.

22 Transcapsular scleral fixation of the standard capsular tension ring and in-the-bag intraocular lens implantation for severely subluxated lenses

Hong-Zhe Li , Fu-Man Yang , Ze-Hui Zhu , Yin-Ying Zhao , Ping-Jun Chang , Yun-E Zhao

2024, 17(12):2321-2326. DOI: 10.18240/ijo.2024.12.22

[Abstract](15) [HTML](0) [PDF 1.09 M](63)

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AIM: To present a technique of transcapsular scleral fixation of the standard capsular tension ring (CTR) through equatorial capsulotomy and in-the-bag intraocular lens (IOL) implantation in subluxated lenses. METHODS: This retrospective consecutive case series included patients with subluxated lenses by more than 180 degrees who underwent lens extraction, transcapsular scleral fixation of the standard CTR through equatorial capsulotomy, in-the-bag IOL implantation and with at least 6mo follow-up. Preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), complications, and postoperative IOL tilt and decentration were recorded. RESULTS: Nine eyes of 7 patients with a mean follow-up of 11.0±3.7mo were included in this study. The BCVA was significantly improved from 0.64±0.22 logMAR preoperatively to 0.21±0.19 logMAR postoperatively (P<0.001). The IOP was within the normal range postoperatively. The mean tilt of the IOL was 4.30°±2.31° (range, 1.0° to 8.9°) and the mean decentration of the IOL was 0.37±0.12 mm (range, 0.14 to 0.50 mm). No visually threatened intraoperative and postoperative complications were detected during the follow-up period. CONCLUSION: This is a safe and effective surgical technique for managing patients with severely subluxated lenses. It has achieved favorable outcomes with fewer surgical manipulations and less need for advanced capsular support devices.

23 Thirty-gauge needle-guided purse-string suture pupilloplasty: a new technique

Chun-Ming Chen , Hong Zhong , Yan Shao , Cheng-Yao Qin , Ze-Hao Liu , Wen-Xiu Sun , Min Li

2024, 17(12):2327-2332. DOI: 10.18240/ijo.2024.12.23

[Abstract](16) [HTML](0) [PDF 1.66 M](60)

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AIM: To observe the clinical outcomes of 30-gauge (G) needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management. METHODS: Eight patients with atonic pupils who underwent suture purse-string pupilloplasty were retrospectively analyzed. Preoperative data and at least 6mo of postoperative data were collected from all the patients. RESULTS: The corrected distance visual acuity (CDVA) before and after surgery was 0.58±0.22 and 0.20±0.10 logMAR, respectively (P=0.002). The pre- and postoperative pupil size was 7.38±0.88 and 3.09±0.71 mm (P=0.000), respectively. The corneal endothelial cell count was 2841±176/mm2 before and 2692±143/mm2 after surgery (P=0.000). No intraoperative or postoperative complications were reported. During the follow-up period of at least 6mo, all treated pupils were centered and generally or nearly round. Furthermore, the patients did not exhibit photophobia, glare, or diplopia. CONCLUSION: This technique is a simple and effective method for pupil reduction.

24 Dacryocystitis and canaliculitis secondary to residual of epidural catheter remaining in lacrimal duct for 25 years: a case report and literature review

Bing-Ran Dong , Ming-Hai Chen , Peng Wang , Hai Tao

2024, 17(12):2333-2335. DOI: 10.18240/ijo.2024.12.24

[Abstract](29) [HTML](0) [PDF 729.01 K](74)

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25 Bilateral cytomegalovirus retinitis in a patient with dyskeratosis congenita

Yu-Fei Gao , Ai-Ping Deng , Kang-Wei Jiao , Run Tian

2024, 17(12):2336-2338. DOI: 10.18240/ijo.2024.12.25

[Abstract](33) [HTML](0) [PDF 1.20 M](71)

Abstract:

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Volume 17,Issue 12,2024 Table of Contents