International Journal of Ophthalmology-IJO is a global ophthalmological scientific publication and a peer-reviewed open access periodical (ISSN 2222-3959 print, ISSN 2227-4898 online). This journal is sponsored by Chinese Medical Association Xi’an Branch and published by the IJO Press. It has been indexed in SCIE, PubMed, PMC, CA, IC, Scopus, EMBASE and DOAJ, and was selected for China's Science and Technology Journal International Influence Enhancement Plan (D-class projects). IJO’s JCR IF in 2024 is 1.8 (Q3), Five-year Impact Factor is 1.8, CiteScore in 2024 is 2.8. IJO was established in 2008, with editorial office in Xi’an, China. It is a monthly publication and accept contributions from all over the world, both basic and clinical research.
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Wei-Hua Yang, Yan-Wu Xu, Xing-Huai Sun, Expert Workgroup of Guidelines for Glaucoma Imaging Classification, Annotation , Quality Control for Artificial Intelligence Applications
2025,18(7):1181-1196 ,DOI: 10.18240/ijo.2025.07.01
Abstract:
Glaucoma is an eye disease characterized by pathologically elevated intraocular pressure, optic nerve atrophy, and visual field defects, which can lead to irreversible vision loss. In recent years, the rapid development of artificial intelligence (AI) technology has provided new approaches for the early diagnosis and management of glaucoma. By classifying and annotating glaucoma-related images, AI models can learn and recognize the specific pathological features of glaucoma, thereby achieving automated imaging analysis and classification. Research on glaucoma imaging classification and annotation mainly involves color fundus photography (CFP), optical coherence tomography (OCT), anterior segment optical coherence tomography (AS-OCT), and ultrasound biomicroscopy (UBM) images. CFP is primarily used for the annotation of the optic cup and disc, while OCT is used for measuring and annotating the thickness of the retinal nerve fiber layer, and AS-OCT and UBM focus on the annotation of the anterior chamber angle structure and the measurement of anterior segment structural parameters. To standardize the classification and annotation of glaucoma images, enhance the quality and consistency of annotated data, and promote the clinical application of intelligent ophthalmology, this guideline has been developed. This guideline systematically elaborates on the principles, methods, processes, and quality control requirements for the classification and annotation of glaucoma images, providing standardized guidance for the classification and annotation of glaucoma images.
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Dong-Qing Yuan, Fu-Nan Tang, Ying Wang, Hui Zhang, Wei-Wei Zhang, Liu-Wei Gu, Qing-Huai Liu
2025,18(7):1197-1204 ,DOI: 10.18240/ijo.2025.07.02
Abstract:
AIM: To predict the post-operative vault and the suitable size of the implantable collamer lens (ICL) by comparing the performance of multiple artificial intelligence (AI) algorithms. METHODS: A retrospective analysis of 83 patients with 132 eyes was conducted from 2020 to 2023. All patients underwent implantation of EVO-V4C ICLs. ICLs were selected based on STAAR’s recommended formula. Postoperative vault values were measured using anterior segment optical coherence tomography (ASOCT). First, feature selection was performed on patients’ preoperative examination parameters to identify those most closely related to postoperative vault and incorporate them into the machine learning model. Subsequently, four regression models, namely MLP, XGBoost, RFR, and KNN, were employed to predict the vault, and their predictive performances were compared. The ICL size was set as the prediction target, with the vault and other input features serving as new inputs for predicting the ICL size. RESULTS: Among all preoperative parameters, 16 parameters were most closely related to postoperative vault and were included in the prediction model. In vault prediction, XGBoost performed the best in the regression model (R²=0.9999), followed by MLP (R²=0.9987) and RFR (R²=0.8982), while the KNN model had the lowest predictive performance (R²=0.3852). XGBoost achieved a prediction accuracy of 99.8%, MLP had a prediction accuracy of 98.9%, while RFR and KNN had accuracies of 87.1% and 57.4%, respectively. CONCLUSION: AI effectively predicts postoperative vault and determines ICL size. XGBoost outperforms other machine-learning algorithms tested. Its accurate predictions help ophthalmologists choose the right ICL size, ensuring proper vaulting.
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Jun-Yi Wu, Yan-Mei Zeng, Xian-Zhe Qian, Qi Hong, Jin-Yu Hu, Hong Wei, Jie Zou, Cheng Chen, Xiao-Yu Wang, Xu Chen, Yi Shao
2025,18(7):1205-1213 ,DOI: 10.18240/ijo.2025.07.03
Abstract:
AIM: To assess the performance of five distinct large language models (LLMs; ChatGPT-3.5, ChatGPT-4, PaLM2, Claude 2, and SenseNova) in comparison to two human cohorts (a group of funduscopic disease experts and a group of ophthalmologists) on the specialized subject of funduscopic disease. METHODS: Five distinct LLMs and two distinct human groups independently completed a 100-item funduscopic disease test. The performance of these entities was assessed by comparing their average scores, response stability, and answer confidence, thereby establishing a basis for evaluation. RESULTS: Among all the LLMs, ChatGPT-4 and PaLM2 exhibited the most substantial average correlation. Additionally, ChatGPT-4 achieved the highest average score and demonstrated the utmost confidence during the exam. In comparison to human cohorts, ChatGPT-4 exhibited comparable performance to ophthalmologists, albeit falling short of the expertise demonstrated by funduscopic disease specialists. CONCLUSION: The study provides evidence of the exceptional performance of ChatGPT-4 in the domain of funduscopic disease. With continued enhancements, validated LLMs have the potential to yield unforeseen advantages in enhancing healthcare for both patients and physicians.
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Yu-Xin Jiang, Si-Yu Gui, Xiao-Dong Sun
2025,18(7):1214-1230 ,DOI: 10.18240/ijo.2025.07.04
Abstract:
AIM: To investigate the associations between urinary dialkyl phosphate (DAP) metabolites of organophosphorus pesticides (OPPs) exposure and age-related macular degeneration (AMD) risk. METHODS: Participants were drawn from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2008. Urinary DAP metabolites were used to construct a machine learning (ML) model for AMD prediction. Several interpretability pipelines, including permutation feature importance (PFI), partial dependence plot (PDP), and SHapley Additive exPlanations (SHAP) analyses were employed to analyze the influence from exposure features to prediction outcomes. RESULTS: A total of 1845 participants were included and 137 were diagnosed with AMD. Receiver operating characteristic curve (ROC) analysis evaluated Random Forests (RF) as the best ML model with its optimal predictive performance among eleven models. PFI and SHAP analyses illustrated that DAP metabolites were of significant contribution weights in AMD risk prediction, higher than most of the socio-demographic covariates. Shapley values and waterfall plots of randomly selected AMD individuals emphasized the predictive capacity of ML with high accuracy and sensitivity in each case. The relationships and interactions visualized by graphical plots and supported by statistical measures demonstrated the indispensable impacts from six DAP metabolites to the prediction of AMD risk. CONCLUSION: Urinary DAP metabolites of OPPs exposure are associated with AMD risk and ML algorithms show the excellent generalizability and differentiability in the course of AMD risk prediction.
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Dong Hee Ha, Ungsoo Samuel Kim
2025,18(7):1231-1236 ,DOI: 10.18240/ijo.2025.07.05
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AIM: To investigate the capabilities of large language models (LLM) for providing information and diagnoses in the field of neuro-ophthalmology by comparing the performances of ChatGPT-3.5 and -4.0, Bard, and Bing. METHODS: Each chatbot was evaluated for four criteria, namely diagnostic success rate for the described case, answer quality, response speed, and critical keywords for diagnosis. The selected topics included optic neuritis, non-arteritic anterior ischemic optic neuropathy, and Leber hereditary optic neuropathy. RESULTS: In terms of diagnostic success rate for the described cases, Bard was unable to provide a diagnosis. The success rates for the described cases increased in the order of Bing, ChatGPT-3.5, and ChatGPT-4.0. Further, ChatGPT-4.0 and -3.5 provided the most satisfactory answer quality for judgment by neuro-ophthalmologists, with their sets of answers resembling the sample set most. Bard was only able to provide ten differential diagnoses in three trials. Bing scored the lowest for the satisfactory standard. A Mann-Whitney test indicated that Bard was significantly faster than ChatGPT-4.0 (Z=-3.576, P=0.000), ChatGPT-3.5 (Z=-3.576, P=0.000) and Bing (Z=-2.517, P=0.011). ChatGPT-3.5 and -4.0 far exceeded the other two interfaces at providing diagnoses and were thus used to find the critical keywords for diagnosis. CONCLUSION: ChatGPT-3.5 and -4.0 are better than Bard and Bing in terms of answer success rate, answer quality, and critical keywords for diagnosis in ophthalmology. This study has broad implications for the field of ophthalmology, providing further evidence that artificial intelligence LLM can aid clinical decision-making through free-text explanations.
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Shan He, Cui-Ying Liu, Chang-Hong Ren, Ting-Ting Meng, Heng Zhao, Xu-Xiang Zhang
2025,18(7):1237-1251 ,DOI: 10.18240/ijo.2025.07.06
Abstract:
AIM: To explore the immune cell infiltration and molecular mechanisms of retinal ischemia-reperfusion injury (RIRI) to identify potential therapeutic targets. METHODS: In the bulk RNA-seq analysis, This study performed differential gene expression analysis, weighted gene co-expression network analysis, and protein-protein interaction network analysis to identify hub genes. QuanTIseq was used to determine the composition of infiltrating immune cells. Following the identification of hub genes, single-cell RNA-seq analysis was employed to pinpoint the specific immune cell types expressing these hub genes. Cell-cell communication analysis to explore signaling pathways and interactions between immune cells was further performed. Finally, the expression of these key immune regulators in vivo using quantitative real-time polymerase chain reaction (qRT-PCR) was validated. RESULTS: Bulk RNA-seq analysis identified Stat2, Irf7, Irgm1, Igtp, Parp9, Irgm2, Nlrc5, and Tap1 as hub genes, with strong correlations to immune cell infiltration. Single-cell RNA-seq analysis further revealed six immune cell clusters, showing Irf7 predominantly in microglia and Tap1 in dendritic cells (DCs). And cell-cell communication analysis showed that microglia and DCs play central roles in coordinating immune activity. qRT-PCR validated the upregulation of these genes. CONCLUSION: In the acute phase of RIRI, Irf7 and Tap1 may be the potential therapeutic targets to reduce inflammation and promote neurological function recovery.
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Ying-Ying Zhu, Shi-Yue Qin, Hai Xie, Yin-Ping Liu, Xiao-Sa Li, Chao-Yang Zhang, Yan-Chun Zhang, Jing-Fa Zhang
2025,18(7):1252-1261 ,DOI: 10.18240/ijo.2025.07.07
Abstract:
AIM: To investigate the effects and the underlying mechanism(s) of conbercept on the phagocytosis of hard exudates (HEs) by Müller glia in diabetic retinopathy (DR). METHODS: Twenty-one eyes from 17 patients with diabetic macular edema (DME) underwent optical coherence tomography (OCT) imaging to examine the changes of HEs before and after intravitreal conbercept injection (IVC). In vitro, rat retinal Müller cell line (rMC-1) was cultured under high glucose and treated with oxidized low-density lipoprotein (Ox-LDL) with or without conbercept. Phagocytosis was analysed with immunofluorescence, flow cytometry, and Western blot. Expressions of scavenger receptors (LOX-1, CD36) were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR). Conbercept’s effects on vascular endothelial growth factor A (VEGF-A), VEGFR2, inflammation (NF-κB, IL-6, iNOS), and oxidative stress (ROS) were evaluated with Western blot and immunofluorescence. RESULTS: The area of HEs showed minimal change after the first IVC (1.39±1.41 to 1.38±1.3 mm2, P=0.938), but significantly decreased after the third IVC (0.45±0.66 mm2, P=0.002). In vitro, conbercept enhanced the phagocytosis of Ox-LDL by rMC-1 cells under high glucose condition. Conbercept reduced ROS and inflammation (NF-κB, IL-6, iNOS) in high glucose-treated rMC-1 cells by suppression of VEGF/VEGFR2 pathway. The inhibition of NF-κB by conbercept further activated PPARγ-CD36 axis, increasing CD36 expression and promoting Ox-LDL uptake, thereby facilitating the clearance of HEs. CONCLUSION: Conbercept reduces HEs in DR by enhancing Müller glia phagocytosis possibly through activating PPARγ-CD36 axis, which is mediated by inhibition of VEGF signaling. Modulation of Müller glia phagocytic capacity might provide a novel therapeutic strategy to treat DR and DME.
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Xin-He Fang, Fa-Yong Ke, Wen-Qing Zou, De-Jun Zhu, Mei-Jiao Ma, Yuan-Yuan Lian, Xue-Li Wu, Rui-Hua Wei, Xun-Lun Sheng
2025,18(7):1262-1269 ,DOI: 10.18240/ijo.2025.07.08
Abstract:
AIM: To analyze the pathogenicity and clinical features of patients in a consanguineous cone-rod dystrophy (CRD) family due to heterozygous variants in the GUCY2D gene. METHODS: Whole exome sequencing was used to screen for pathogenic genes and candidate pathogenic variants were obtained by bioinformatics analysis. Sanger sequencing was used for validation and familial co-segregation analysis to determine pathogenic variants. Pymol software was applied to produce a 3D structure image of the protein to analyze the structural and functional alterations of the protein. The pathogenicity of genetic variants was evaluated according to ACMG guidelines. RESULTS: The chief clinical symptoms of this proband included obvious visual impairment, protanopia and deuteranopia, peripheral punctate pigment, arteriolar attenuation, structural and functional abnormalities revealed by optical coherence tomography (OCT) and electroretinography (ERG) including thinning of the outer retinal layer, a discontinuous external limiting membrane (ELM) and ellipsoid zone (EZ), granular hyperreflective projections between the retinal pigment epithelium and the interdigitation zone, severe attenuation of photopic responses with mild reduced scotopic responses. Whole-exome sequencing revealed that the proband carried a heterozygous variant of the GUCY2D gene: c.2512C>T: p.Arg838Cys. Three-dimensional molecular structure analysis of the protein revealed that amino acid 838 was mutated from polar positively charged arginine to polar uncharged cysteine, and the spatial structure of the protein changed greatly. Sanger sequencing co-segregation analysis confirmed that such a variant was detected in neither the phenotypically normal parents nor the daughter of the proband, which was presumed to be a de novo one. The variant was determined to be pathogenic according to ACMG guidelines. The heterozygous variant at the same site was detected in the abnormal proband’s son with moderate attenuation of photopic electroretinographic responses and normal scotopic electroretinographic responses, supporting autosomal dominant inheritance. CONCLUSION: The de novo variant causing atypical autosomal dominant CRD is identified in a Chinese consanguineous family and this variant passes through this family in an autosomal dominant mode of inheritance, revealing the complex diversity and unpredictability of the inheritance mode for common single-gene genetic disease.
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Yue-Qing He, Xiao-Bo Tian, Yang Zhang, Hua Sun
2025,18(7):1270-1275 ,DOI: 10.18240/ijo.2025.07.09
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AIM: To determine the microbiological agents and antibiotic susceptibility of chronic dacryocystitis in recent years to guide effective treatment strategies. METHODS: A total of 308 adult patients with chronic dacryocystitis were enrolled from January 2020 to September 2022 in Beijing Tongren Hospital. The 229 pus specimens were taken from the conjunctival sac, while 79 specimens were taken from the opened lacrimal sac during transnasal dacryocystorhinostomy (DCR) surgery. All the samples were sent for microbiological smear and culture and drug susceptibility tests. RESULTS: The 202 specimens showed microbial growth, with a positive rate of 65.6%. The 313 strains of bacteria were isolated, including 272 aerobic or facultative anaerobes, accounting for 86.9%, and 41 anaerobic bacteria, accounting for 13.1%. The most common strains were Staphylococcus epidermidis, Corynebacterium macginleyi, and Staphylococcus aureus. Six strains of fungi were isolated. The 14 strains (18.9%) of Staphylococcus were found to be multidrug resistant. It showed a wide variety of gram-negative bacteria, up to 23 species. Specimens obtained during DCR surgery had a positive rate of 70.9%, which was higher than those obtained from the conjunctival sac (63.8%), with a statistically significant difference. More microbiological species were found in intraoperative specimens, and consisted largely of pathogenic bacteria or conditional pathogens. All the 6 strains of fungi were obtained from intraoperative specimens. All bacteria were sensitive to vancomycin, while a large number of bacteria were resistant to erythromycin. The commonly used ocular antibiotics levofloxacin, moxifloxacin and tobramycin were generally sensitive to most of the bacteria. CONCLUSION: Gram-positive cocci, gram-positive bacilli, and gram-negative bacilli are the predominant pathogens for chronic dacryocystitis. Specimens taken during DCR surgery can obtain more accurate microbiological results.
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Yue Ying, Rui-Ling Zhao, Ya-Nan Sun, Qi-Lian Sheng, Ye Lin Kwan, Xiang-Mei Kong
2025,18(7):1276-1281 ,DOI: 10.18240/ijo.2025.07.10
Abstract:
AIM: To study the relationship between ultrasound biomicroscopy (UBM) and Lenstar when measuring anterior chamber depth (ACD) in eyes with shallow anterior chamber, and the necessity of conducting both examinations. METHODS: This is a retrospective observational study including 56 acute primary angle closure (APAC) eyes and 47 primary angle closure suspect (PACS) eyes with shallow ACD. ACD value measured by Lenstar and UBM were documented. The Bland-Altman plots were examined separately in all included eyes, APAC eyes and PACS eyes, for the assessment of agreement between two measurements. The agreement was compared across different population by evaluating mean difference, width of 95% limit of agreement (LoA) and the presence of proportional bias or outliers in Bland-Altman plots. RESULTS: The average ACD in APAC eyes (1.71±0.23 mm) was significantly smaller than that in PACS eyes (1.79±0.25 mm, P=0.038). Bland-Altman plots of both APAC eyes and PACS eyes showed small mean difference without the presence of proportional bias. However, compared with PACS eyes, the Bland-Altman plot of APAC eyes had wider 95% LoA and more outliers outside the 95% LoA. CONCLUSION: Despite the small ACD values, the two methods in measuring ACD, Lenstar and UBM, demonstrate substantial consistency when measuring PACS eyes. However, for the APAC population, the agreement might be limited, and thus the measured values should be interpreted with caution.
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Jia-Xi Li, Yi-He Liu, Yu-Shi Liu, Zi-Yuan Liu, Xue-Min Li
2025,18(7):1282-1293 ,DOI: 10.18240/ijo.2025.07.11
Abstract:
AIM: To investigate the relationship between preoperative corneal biomechanical properties and corneal tomographic properties in cataract patients. METHODS: The study consisted of 59 eyes of 30 participants who were diagnosed as cataract in Peking University Third Hospital between September 2019 and November 2019. Stepwise multivariable linear regression analysis was calculated to determine the relationship between corneal biomechanical parameters and tomographic parameters. The patients were classified into three groups of with the rule (WTR) astigmatism, against the rule astigmatism and oblique astigmatism. And the differences in corneal parameters among different groups were compared. RESULTS: There were significant differences in the first applanation time (A1T), the first applanation length (A1L), corneal velocity during the first applanation (Vin), the second applanation time (A2T), highest concavity (HC) radius, displacement amount (DA), DA ratio, stiffness parameter A1 (SPA1) and integrated radius (IR) between oblique astigmatism patients and the other two groups. Total corneal steep meridian (K2) was negatively associated with A1L, A1T and corneal velocity during the second applanation (Vout). Patients with higher anterior corneal curvature had lower HC radius and central corneal thickness (CCT; P=0.001 and 0.006, respectively), while the Ambrosio relational thickness to the horizontal profile (ARTh) was higher than those with lower anterior corneal curvature (P=0.009). CONCLUSION: The study reveals that the elasticity of corneal collagen fibers is greater, but the viscoelasticity of cornea is smaller in patients with oblique astigmatism. There is no significant difference in ARTh between patients with different types of astigmatism, that is, the corneal biomechanical specificity of oblique astigmatism group is probably not caused by corneal thickness. Moreover, we find patients with higher anterior corneal curvature has lower HC radius and CCT but higher ARTh than those with lower anterior corneal curvature.
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Ying-Shi Zou, Jia-Xin Jin, Yun-Qian Li, Ling Jin, Jing-Min Xu, Wei-Ning Zhu, Hui Chen, Qiu-Xia Yin, Yi-Zhi Liu, Zhen-Zhen Liu
2025,18(7):1294-1301 ,DOI: 10.18240/ijo.2025.07.12
Abstract:
AIM: To evaluate the accuracy of intraocular lens (IOL) power calculation formulas with/without preoperative aphakic anterior chamber depth (aph-ACD) in pediatric aphakia. METHODS: A total of 102 pediatric patients (150 eyes) undergoing secondary IOL implantation were divided into two groups (in-the-bag or ciliary sulcus). Prediction error was calculated for 9 IOL power calculation formulas, including: 1) not requiring ACD: Hoffer Q, Holladay 1, SRK/T; 2) usable without or with entering ACD: Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO) 2.0, and Ladas Artificial Intelligence Super (Ladas AI); 3) requiring ACD: Haigis, Kane, and Pearl-DGS. Mean prediction error (ME), mean absolute error (MAE), median absolute error (MedAE) and the percentage of eyes within ±0.25, ±0.50, ±0.75, and ±1.00 D were calculated. RESULTS: For the BUII, EVO 2.0, and Ladas AI, with aph-ACD demonstrated a higher MedAE compared to without aph-ACD (BUII: 1.27 vs 1.13 D, EVO 2.0: 1.26 vs 1.06 D, Ladas AI: 1.30 vs 1.10 D; all P<0.05). Formulas requiring ACD (Haigis, Kane, and Pearl-DGS) exhibited larger MedAE than those not requiring aph-ACD (Hoffer Q, Holladay 1, and SRK/T; P<0.05). In the capsular group, the percentage of eyes within ±1.00 D ranged from 44.83% to 74.14%, and it was 19.57% to 32.61% in the sulcus group. CONCLUSION: The introduction of aph-ACD does not improve the accuracy of IOL calculation for pediatric aphakia, regardless of in-the-bag or sulcus IOL secondary implantation. The relationship between aph-ACD and effective lens position in pediatric aphakia warrants further study.
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Gonçalo Cavaco Tardão, Pedro Carreira, Filipe Moraes, Rita Carreira, Tomás Loureiro, Ana Vide Escada, Maria José Santos, Ana Melo Cardoso, Nuno Campos
2025,18(7):1302-1306 ,DOI: 10.18240/ijo.2025.07.13
Abstract:
AIM: To characterize a Portuguese population of patients with juvenile idiopathic arthritis (JIA) and to evaluate possible associations between clinical factors and ocular involvement. METHODS: Patients diagnosed with JIA in the previous 20y in Hospital Garcia de Orta were included. Data were assessed from Reuma.pt database. Associations between demographic (age and sex), clinical (articular involvement, extra-articular manifestations, biological therapy), laboratory data [anti-nuclear antibodies, anti-cyclic citrullinated peptide (CCP) antibodies, rheumatoid factor, human leukocyte antigen B27 (HLA-B27), C-reactive protein, erythrocyte sedimentation rate] and ocular involvement were assessed. Statistical analysis was performed using Chi-square for categorical variables and Mann-Whitney test for continuous variables. RESULTS: Totally 91 patients were included, 11 (12%) with previous episodes of uveitis. There was a statistically significant preponderance of early age at JIA diagnosis (mean 4.73 vs 9.58y, P=0.008), antinuclear antibodies positivity (P=0.01), and oligoarticular subtype (P=0.04) in the Juvenile idiopathic arthritis-associated uveitis (JIA-U) group. Ocular complications occurred in 36.4% of patients (n=4): cataracts (n=2), band keratopathy (n=1) and posterior synechiae (n=1). The occurrence of complications was corelated with a shorter period between JIA diagnosis and the first JIA-U episode (mean 0.67 vs 4.88y, P=0.012) but not with age at JIA diagnosis or articular involvement. There was erythrocyte sedimentation rate elevation in the 12mo preceding uveitis (mean 40.5 mm/h, range 13-83). CONCLUSION: The occurrence of JIA-U shortly after JIA diagnosis is shown to be a potential risk factor for ocular complications.
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Li-Yun Yuan, Wang-Ming Su, Liang-Pin Li, Xiao-Feng Tian, Xue-Li Zheng, Xiao-Yong Yuan
2025,18(7):1307-1316 ,DOI: 10.18240/ijo.2025.07.14
Abstract:
AIM: To elucidate causal pathways between oxidative biomarkers and age-related macular degeneration (AMD) phenotypes. METHODS: A bidirectional Mendelian randomization (MR) analytical protocol was implemented, which utilized genome-wide association study (GWAS) summary statistics derived from the IEU OpenGWAS repositories. The investigation focused on 11 oxidative stress markers and AMD phenotypes, encompassing both wet and dry subtypes. The MR methodology incorporated inverse-variance weighted (IVW) calculations, MR-Egger statistical regression, weighted median approximation, and weighted mode assessments to estimate causative relationships. Sensitivity evaluations were conducted to verify result robustness and identify potential pleiotropy. RESULTS: Genetically predicted elevated catalase (CAT) concentrations demonstrated significant associations with heightened risks of overall AMD (IVW OR=1.084, 95%CI: 1.021-1.151, P=0.008) and wet AMD phenotype (IVW OR=1.113, 95%CI: 1.047-1.247, P=0.007). Higher genetically predicted albumin concentrations corresponded with reduced AMD risk (IVW OR=0.827, 95%CI: 0.715-0.957, P=0.013) but increased wet AMD risk (IVW OR=1.229, 95%CI: 1.036-1.458, P=0.018). Reverse MR analysis revealed that genetically predicted dry AMD exhibited significant association with reduced albumin levels (IVW OR=0.987, 95%CI: 0.979-0.996, P=0.004), while wet AMD corresponded with decreased total bilirubin (TBIL) and paraoxonase (PON) activity. CONCLUSION: The results offer strong support for a causal link between markers of oxidative stress and the development of AMD, indicating that oxidative processes play a role in driving the disease progression.
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Wu-Yang Jiang, Man-Hong Li, Hao Wang, Dong Niu, Yu-Sheng Wang, Zi-Feng Zhang
2025,18(7):1317-1325 ,DOI: 10.18240/ijo.2025.07.15
Abstract:
AIM: To compare the changes in preschool refractive status, ocular biological parameters, and higher-order aberrations in children with retinopathy of prematurity (ROP) after retinal laser photocoagulation or anti-vascular endothelial growth factor (anti-VEGF) treatment and explore their underlying factors. METHODS: This observational study involved 118 eyes of 59 children, aged 3 to 6y, with ROP followed up between March 2023 and October 2024. They were divided into the laser, anti-VEGF, and anti-VEGF+laser groups. The laser group received a single session of laser photocoagulation. The anti-VEGF group received a single anti-VEGF treatment. The anti-VEGF+laser group received a single anti-VEGF treatment after birth followed by supplementary laser treatment within 2wk to 6mo. Ocular biological parameters were measured using IOL Master 700 and Pentacam HR. Right-eye higher-order aberrations were measured using the OPD-Scan III. Best-corrected visual acuities (BCVA), refractive statuses, ocular biological parameters, and higher-order aberrations were assessed and compared. Multiple linear regression analysis was conducted to evaluate the relationships among ocular biological parameters, higher-order aberrations, spherical equivalent (SE), and treatment methods. Pearson’s correlation coefficients were used to assess the relationships between the SE and higher-order aberrations. RESULTS: The laser group had a higher incidence of myopia and a lower SE than the anti-VEGF group. The incidence of astigmatism and cylindrical power were significantly lower for the anti-VEGF than for the laser and anti-VEGF+laser groups (P<0.05). The anterior corneal surface astigmatism was higher for the laser and anti-VEGF+laser groups than for the anti-VEGF group. The anterior corneal surface K2 and lens thickness were higher for the laser and anti-VEGF+laser groups than for the anti-VEGF group. The whole-eye higher-order aberration root mean square (RMS) values for the right eye were significantly higher for the laser and anti-VEGF+laser groups than for the anti-VEGF group. The whole-eye trefoil RMS values for the right eye were also significantly higher for the laser and anti-VEGF+laser groups than for the anti-VEGF group (P<0.05). Laser treatment was significantly associated with SE, anterior corneal surface curvature and astigmatism, lens thickness, whole-eye high-order aberrations, and whole-eye trefoil (all P<0.05). CONCLUSION: Children with ROP who received laser treatment have higher myopia and astigmatism than those who received anti-VEGF treatment. Children treated with laser or supplementary laser treatment have higher anterior corneal astigmatism, anterior corneal curvature, thicker lenses, whole-eye higher-order aberrations, and whole-eye trefoil. The cause of myopia in children with ROP after laser treatment is increased anterior corneal surface curvature and lens thickness.
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Yoo-Ri Chung, Chungwoon Kim, Eunzee Lee, Kihwang Lee
2025,18(7):1326-1332 ,DOI: 10.18240/ijo.2025.07.16
Abstract:
AIM: To investigate the effects of dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) on diabetic macular edema (DME) and the need for intravitreal injections (IVT) in patients with type 2 diabetes. METHODS: Data were retrospectively collected from the medical records of patients with diabetic retinopathy (DR) taking either DPP4i or SGLT2i as secondary oral hypoglycemic agents in addition to metformin between January 2019 and July 2022. We compared the prevalence of DME and the need for IVT among patients treated with DPP4i or SGLT2i. Propensity score matching was performed using the following variables: age, duration of diabetes, blood glucose control (HbA1c) level, and severity of DR. RESULTS: A total of 268 patients with DR were included in this study. More DPP4i users needed IVT than SGLT2i users (35.3% vs 18.0%, P=0.011), while the prevalence of DME was not different. The use of SGLT2i was associated with a lower need for IVT than DPP4i [odds ratio (OR) 0.404, 95% confidence interval (CI) 0.198–0.823], and similar trends were observed after propensity score matching (OR 0.419, 95%CI 0.181–0.970). However, this tendency was not significant in multiple logistic regressions. For DME, the use of DPP4i was not a significant risk factor compared to SGLT2i. CONCLUSION: The use of SGLT2i may be associated with a lower need for IVT for overall DR complications, while other factors may contribute to this effect. The effect of SGLT2i on the prevention of DME is not evident.
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Multiple imaging modalities in intraocular silicone oil emulsification and its related complications
Jia-Wei Wang, Jing Su, Fei-Yan Ma, Jin Wang, Ying Liu, Jin-Xin Shi, Jing-Xue Ma, Dan-Yan Liu
2025,18(7):1333-1340 ,DOI: 10.18240/ijo.2025.07.17
Abstract:
AIM: To elucidate the manifestations and associated complications observed in patients with intraocular silicone oil (SO) emulsification through multiple imaging modalities. METHODS: This single-center, observational, retrospective study included 116 patients who underwent pars plana vitrectomy (PPV) with SO injection for retinal detachment (RD), followed by subsequent SO removal at the Second Hospital of Hebei Medical University from January 2013 to January 2023. Comprehensive records of ophthalmic examinations utilizing multiple imaging techniques were maintained. RESULTS: The study comprised 56 females and 60 males, with a mean age of 52.75±13.6y. The mean follow-up duration for SO tamponade was 9.04±11.33mo (range: 1-84mo). Among the participants, 59 patients were diagnosed with SO emulsification, while 57 patients were in the SO unemulsified group. Patients with SO emulsification had a significantly prolonged SO tamponade duration (P<0.01). Multiple imaging techniques revealed notable signs of SO emulsification and its complications, such as 4 cases (3.4%) with posterior corneal SO-like keratic precipitates (KP) observed by anterior segment photography, 23 cases (19.8%) exhibiting spherical high-reflection signals in the inter-retina, retinal pigment epithelium, or choroid detected by Spectralis spectral domain optical coherence tomography (SD-OCT), 4 cases (3.4%) showing slow movement of emulsified SO droplets within retinal vessels during fluorescein angiography (FFA), plain and enhanced head magnetic resonance imaging (MRI) images of these four patients did not detect emulsified SO in the lateral ventricles, suprasellar cistern, subarachnoid space, third ventricle, fourth ventricle, or other intracranial locations. CONCLUSION: Intraocular emulsified SO can lead to damage in both anterior and posterior segment tissues, encompassing corneal degeneration, cataracts, glaucoma, retinal and choroid inflammation. Objective multiple imaging techniques such as anterior segment photography, SD-OCT, FFA, and MRI offer comprehensive evaluation and diagnosis of SO emulsification and its associated complications.
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Valenchia, Yunita Mansyur, Alia Arianti, Viona
2025,18(7):1341-1348 ,DOI: 10.18240/ijo.2025.07.18
Abstract:
AIM: To characterize the demographic and clinical features of ethambutol optic neuropathy (EON) in an Indonesian patient population and explore prognostic factors for visual recovery. METHODS: Retrospective study of 58 EON patients at an Indonesian eye center (2017-2022). Demographics, ethambutol treatment, ophthalmologic findings were collected. Visual outcomes after ethambutol cessation assessed at 3-12mo. Patients categorized as having visual improvement (≥2 Snellen lines and/or >5° visual field gain) or no improvement. RESULTS: Mean age was 55.5±12.9y, with 56.9% females. Median duration of ethambutol use was 9mo (range: 2-20) at a mean daily dose of 19.7±5.3 mg/kg. At presentation, mean visual acuity was 1.3 logMAR (range: 0-2.5), with normal fundus appearance in 72.4% of eyes. The most common visual field defect was generalized depression (52.4%). After ethambutol cessation, 56.9% of patients had visual improvement. Younger age (50.24±13.8y vs 62.14±8.9y, P<0.01), lower ethambutol dose (17.3±5 vs 23.3±2.9 mg/kg‧d, P<0.01), shorter treatment duration (6.79±2.6mo vs 10.27±1.2mo, P<0.01), and absence of hypertension (16% vs 83%, P=0.012) or kidney disease (0 vs 83%, P<0.01) were associated with higher likelihood of visual improvement. Diabetes did not differ between groups (P=0.889). CONCLUSION: Over half experience visual recovery after ethambutol cessation. Younger age, lower cumulative dose, absence of hypertension or kidney disease predict better visual outcomes.
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Yin Liu, Cheng Hu, Juan Yu, Nian Xiang, Bo Zeng, Wen-Shan Jiang
2025,18(7):1349-1356 ,DOI: 10.18240/ijo.2025.07.19
Abstract:
AIM: To compare the visual outcomes and corneal higher-order aberrations (HOAs) of patients with high or low myopic astigmatism after small incision lenticule extraction (SMILE). METHODS: A total of 157 eyes of 157 patients who underwent SMILE were included in this retrospective, nonrandomized, comparative study. All the eyes which were with the rule astigmatism were divided into high astigmatism group (HAG; astigmatism ≤-2.00 D, 73 eyes) and low astigmatism group (LAG; astigmatism ≥-1.00 D, 84 eyes). Visual and refractive examinations were performed, HOAs of the anterior surface, posterior surface, and total cornea of the eyes were evaluated preoperatively and 6mo postoperatively. RESULTS: At the postoperative 6-month follow-up, uncorrected distance visual acuity of 20/20 or better was achieved in 97% and 100% eyes in HAG and LAG respectively and 74% and 100% eyes were within -0.50 D. Vector analysis revealed no significant differences in the correction index (P=0.066), angle of error (P=0.091) or flattening index (P=0.987) between two groups. The magnitude of error was -0.37±0.31 D in HAG and -0.04±0.19 D in LAG (P<0.001). Index of success (IOS) was 0.22±0.09 in the HAG and 0.50±0.46 in the LAG (P<0.001). HOAs of most anterior, posterior and total cornea significantly increased after SMILE, especially the spherical aberration and coma. For HAG, the SMILE procedure induced significantly higher anterior, posterior and total cornea horizontal coma and total corneal total HOAs compared with LAG (P<0.001) and these surgically induced HOAs predominantly originated from the anterior surface of the cornea. CONCLUSION: SMILE surgery induces more HOAs and a mild under-correction of astigmatism in eyes with high astigmatism. The increment in HOAs after SMILE is related to preoperative astigmatism.
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Meng Xie, Jin Chen, Ya-Yan You, Zi-Xuan Su, Xi-Yin Zhu, Xing-Hua Wang, Peng-Cheng Li, Fa-Gang Jiang
2025,18(7):1357-1368 ,DOI: 10.18240/ijo.2025.07.20
Abstract:
AIM: To investigate the clinicopathological features of cranial-nasal-orbital communicating lesions and identify key diagnostic indicators for differentiating benign and malignant neoplasms. METHODS: The retrospective cohort study analyzed 74 histologically confirmed cases stratified by anatomical involvement at the Wuhan Union Hospital between January 2010 and December 2020: Group A (orbital-nasal group, n=29), Group B (orbital-cranial group, n=27), and Group C (cranial-nasal-orbital group, n=18). Clinicopathological profiles including symptom presentation, histopathology, and invasion patterns were systematically evaluated. RESULTS: The cohort comprised 49 (66.2%) benign and 25 (33.8%) malignant lesions. Compared with benign lesions, malignant lesions had a shorter onset time (12mo vs 2.5mo, P=0.004) and resulted in poorer vision (0.6 vs 1.53, P=0.025). Headache was reported in 28.6% of patients with benign lesions, but none in those with malignant lesions (P=0.002). Conjunctival congestion and edema were observed in 32.7% of patients with benign lesions and 60% of patients with malignant lesions (P=0.028). The ethmoid sinus was the most frequently invaded site (35 cases). Malignant lesions showed greater invasion in the nasal cavity (28.0% vs 0, P=0.000) and anterior cranial fossa (40.0% vs 8.2%, P=0.003) than benign lesions. The orbital-cranial group was more likely to invade through osseous foramina compared with the orbital-nasal group (P=0.002). Neurogenic tumors predominated benign cases (34.7%), whereas blood derived (28%) and glandular tumors (28%) were most prevalent in malignant subgroups. The proportion of malignant tumors in multi-disciplinary combined surgery was higher than that of benign lesions (61.5% vs 38.5%). CONCLUSION: Malignant cranial-nasal-orbital communicating lesions exhibit distinct clinicopathological signatures characterized by rapid progression, aggressive anterior fossa and nasal region, and severe visual morbidity.
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Jai A. Kelkar, Harsh H. Jain, Aditya S. Kelkar, Shreekant Kelkar
2025,18(7):1369-1374 ,DOI: 10.18240/ijo.2025.07.21
Abstract:
AIM: To describe the demographics, clinical characteristics and treatment outcomes of childhood amblyopia in a tertiary eye center in western India. METHODS: This was a retrospective longitudinal hospital-based study of 1382 children aged ≤12y included in the National Institute of OphthalMology AmBlyopia StUdy in Indian Paediatric EyeS (NIMBUS) Study. Data on patient demographics, treatment approach, and best-corrected visual acuity (BCVA) changes were reviewed. RESULTS: The mean age of the study cohort was 4.54±2.46y, with males constituting the majority (55.4%). The cause of amblyopia was refractive error in 73.2%, strabismus in 7.3%, and anisometropia in 6.8% of eyes. The majority of therapies comprised glasses (74.4%), followed by occlusion+glasses (10.3%), occlusion alone (7.3%), and surgery+patching+glasses (5.1%). The mean occlusion time was 2.46±1.14h. After a median follow-up of 10.00 (6–85)mo, the mean BCVA significantly improved from 0.85±0.41 to 0.55±0.42 logMAR. Subgroup analysis revealed BCVA gain for all etiologies, including refractive errors (P<0.001), strabismus (P<0.001), cataract (P<0.001), and ptosis (P<0.001). Additionally, eyes with refractive errors showed significantly better BCVA than eyes with cataracts (P<0.001), strabismus (P<0.001) and marginally better BCVA than eyes with ptosis (P<0.05), both at the baseline and final visit. CONCLUSION: Refractive errors are the commonest cause of amblyopia, followed by strabismus and anisometropia. Timely detection, optimal therapy, and periodic follow-up are crucial in bettering visual acuity regardless of the cause.
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Xing-Yu He, Wei-Wei Chen, Qian Wang
2025,18(7):1375-1382 ,DOI: 10.18240/ijo.2025.07.22
Abstract:
AIM: To summarize and quantitatively evaluate vasculature alteration of foveal zone in systemic lupus erythematosus (SLE) patients by secondary literature analysis. METHODS: A systematic search of PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI WanFang Data and VIP was conducted. Studies were about retinal vessel density in SLE patients from January 2000 to April 2023 and valid data were extracted. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to evaluate the cross-sectional studies and prospective studies. The measurement data for combined effect size were weighted mean difference (WMD) and 95% confidence interval (CI). The heterogeneity was evaluated by I2 test. The fixed-effect model was adopted when P>0.1 or I2<50%, and random-effect model was adopted in the contrary. Subgroup and sensitivity analysis were utilized to analyze the sources of heterogeneity. The publication bias was evaluated by Egger tests and funnel plots. RESULTS: A total of 14 studies with 445 subjects and 441 healthy controls from 9 countries were enrolled and 11 studies were included in Meta-analysis. The JBI scores of studies were no less than 14 points. The Meta-analysis results indicated that mean parafoveal superficial vessel density (SVD; WMD=-1.22, 95%CI: -1.67, -0.76), mean perifoveal SVD (WMD=-1.42, 95%CI: -1.95, -0.89), mean whole SVD (WMD=-1.66, 95%CI: -2.53, -0.79), mean parafoveal deep vessel density (WMD=-1.67, 95%CI: -2.75, -0.59) and mean whole deep vessel density (WMD= -4.09, 95%CI: -7.67, -0.52) was significantly lower than the control, while mean foveal SVD (WMD=-1.71, 95%CI: -4.65, 1.24), mean foveal avascular zone (FAZ) area (WMD=0.04, 95%CI: -0.01, 0.09) and mean acircularity index (AI; WMD=0.00, 95%CI: -0.02, 0.02) were not different between SLE patients and controls. Subgroup analysis indicated that the heterogeneity in SVD was partially due to the scanning area. Ocellus or binoculus data contributed partially to the heterogeneity in parafoveal deep vessel density and FAZ area. Sensitivity analysis indicated that the results were robust after changing the analysis model except for foveal SVD and FAZ area. There was no bias in included studies except whole SVD. CONCLUSION: Parafoveal superficial and deep vessel density are significantly lower in SLE patients while FAZ area and AI are not different between SLE patients and the control.
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Jiao-Man Wang, Yin-Wei Song, Jing-Jing Su, Li-Cheng Fu, Di Gong, Ping Guo, Wei-Hua Yang
2025,18(7):1383-1397 ,DOI: 10.18240/ijo.2025.07.23
Abstract:
In recent years, Mendelian randomization (MR) has been increasingly utilized, leveraging genetic variants as instrumental variables. This approach significantly mitigates confounder effects and reverse causation, precisely clarifying the causal links between exposures and outcomes. MR’s unique advantages have made it instrumental in medicine, especially in elucidating glaucoma’s etiology. It facilitates the identification of potential risk factors, laying the groundwork for developing preventative and therapeutic strategies against glaucoma. Recent MR research has delved into diverse potential glaucoma risk factors, including behavioral habits, metabolic profiles, and their causative linkage to the disease. This review encapsulates MR’s analysis in glaucoma etiology, heralding new avenues for understanding underlying mechanisms and establishing causality.
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Huang-Yi Lei, Feng Jiang, Zheng-Gao Xie
2025,18(7):1401-1404 ,DOI: 10.18240/ijo.2025.07.25
Abstract:
Volume 18,2025 Issue 7
Intelligent Ophthalmology
Basic Research
Clinical Research
Investigation
Meta-Analysis
Review Article
Letter to the Editor
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Algorithm of automatic identification of diabetic retinopathy foci based on ultra-widefield scanning laser ophthalmoscopy
Jie Wang, Su-Zhen Wang, Xiao-Lin Qin, Meng Chen, Heng-Ming Zhang, Xin Liu, Meng-Jun Xiang, Jian-Bin Hu, Hai-Yu Huang, Chang-Jun Lan
Abstract:
● AIM: To propose an algorithm for automatic detection of diabetic retinopathy (DR) lesions based on ultra-widefield scanning laser ophthalmoscopy (SLO). ● METHODS: The algorithm utilized the FasterRCNN (Faster Regions with CNN features)+ResNet50 (Residua Network 50)+FPN (Feature Pyramid Networks) method for detecting hemorrhagic spots, cotton wool spots, exudates, and microaneurysms in DR ultra-widefield SLO. Subimage segmentation combined with a deeper residual network FasterRCNN+ResNet50 was employed for feature extraction to enhance intelligent learning rate. Feature fusion was carried out by the feature pyramid network FPN, which significantly improved lesion detection rates in SLO fundus images. ● RESULTS: By analyzing 1076 ultra-widefield SLO images provided by our hospital, with a resolution of 2600×2048 dpi, the accuracy rates for hemorrhagic spots, cotton wool spots, exudates, and microaneurysms were found to be 87.23%, 83.57%, 86.75%, and 54.94%, respectively. ● CONCLUSION: The proposed algorithm demonstrates intelligent detection of DR lesions in ultra-widefield SLO, providing significant advantages over traditional fundus color imaging intelligent diagnosis algorithms.
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Abstract:
AIM: To explore the correlation between several blood cell-associated inflammatory indices including mean platelet volume (MPV), platelet distribution width (PDW), neutrophil to lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), and the presence and severity of diabetic retinopathy (DR). METHODS: We searched for eligible studies from PubMed, EMBASE, Web of Science and CNKI up to December 13, 2017. Standardized mean difference (SMD) calculated with confidence interval (CI) of 95% was used to estimate the values of those indices. RESULTS: A total of 31 studies were included in the present Meta-analysis. As compared with type 2 diabetes mellitus (T2DM) patients without DR, the values of MPV, PDW, NLR, and PLR were higher in patients with DR (SMD=0.67; 95%CI: 0.36 to 0.98; SMD=0.51; 95%CI: 0.27 to 0.75; SMD=0.77; 95%CI: 0.49 to 1.05 and SMD=1.18; 95%CI: 0.07 to 2.28). Additionally, it was also observed that MPV was closely correlated with the severity of DR. CONCLUSION: MPV, PDW, NLR, and PLR could be recommended as diagnostic biomarkers for DR, and MPV could be applied to assess the severity of DR.
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Arshad Ali Lodhi, Sameen Afzal Junejo, Mahtab Alam Khanzada, Imran Akram Sahaf, Zahid Kamal Siddique
Abstract:
AIM: To evaluate the surgical outcome of congenital upper eyelid coloboma repair. · METHODS: All patients underwent complete ophthalmic and general examination before going to surgery, and then examination under anesthesia was performed to assess the site and size of eyelid defect, conjunctival involvement. The status of cornea and ocular motility with forced duction test was also being noted. The surgical procedure was performed according to the size of defect. · RESULTS: Out of 21 cases of congenital upper eyelid coloboma, 18 occurred in isolation with upper eyelid medial defect, 13 were bilateral and 5 were unilateral. Others were associated with Goldenhar syndrome and CHARGE syndrome with bilateral upper lid medial defects. All patients were presented for surgical corrections during age of 2.5-4.0 years except one that presented at 25 years of age. Cosmetically surgical results were acceptable, except one that was already presented with opaque corneal. · CONCLUSION: In this study, overall surgical results were satisfactory except one that was presented late with compromised cornea.
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Veronica E. Giordano, Sergio E. Hernandez-Da Mota, Tania N. Adabache-Guel, Armando Castillejos-Chevez, Sonia Corredor-Casas, Samantha M. Salinas-Longoria, Rafael Romero-Vera, Juan M. Jimenez-Sierra, Jose L. Guerrero-Naranjo, Virgilio Morales-Canton
Abstract:
AIM: To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection. METHODS: Eighteen New Zealand white rabbits were divided into three treatment groups (groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group. The right eye was injected with the drug and the left eye received intravitreal injection of 5% dextrose water and served as control eye. The doses delivered to each group were 0.1 mg/0.1 mL, 1 mg/0.1 mL and 10 mg/0.1 mL. Simultaneous, bilateral, dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection (baseline) and after 7, 14, 21 and 28d, followed by enucleation for histological examination. RESULTS: Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3 (Kruskall-Wallis test, P=0.000). By day 7, no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3, consistent with severe damage due to retinal toxicity. Light microscopy revealed no significant histopathological changes in the group 1, while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases. CONCLUSION: Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with 1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.
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Anteneh Amsalu, Kindie Desta, Demiss Nigussie, Demoze Delelegne
Abstract:
AIM: To assess the pattern of ocular manifestation and associated factors among human immunodeficiency virus (HIV) /acquired immunodeficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART) at Hawassa University Referral Hospital, Southern Ethiopia. METHODS: A cross sectional study was conducted from January 2014 to April 2015. After obtaining informed written consent, 240 adult HIV/AIDS patients on HAART were randomly selected regardless of their ophthalmic symptoms, WHO status or CD4 count. Data were collected using structured questionnaires and ophthalmologic clinical examination. Data were entered and analyzed using SPSS version 20.0 software. RESULTS: The mean duration of HAART was 62.5mo. The prevalence of HIV related ocular manifestation was 14.2%. Seborrheic blepharitis (5%) was the most common ocular manifestation, followed by squamoid conjunctival growth (3.8%). The rate of ocular manifestation was significantly higher among study participants who had CD4+ count <200 cells/μL (AOR=3.83; 95%CI: 1.315-11.153), low duration of HAART (AOR=3.0; 95%CI: 1.305-6.891) and who had primary school education [odds ratio (OR) =2.8; 95%CI: 1.105-7.099]. Prevalence of visual impairment and blindness was 10.9% and 5.8%, respectively. CONCLUSION: HAART may be the reason for the decline in the prevalence of ocular manifestation in HIV/AIDS patients in the study area. Ophthalmologic screening of HIV/AIDS patients, especially those with CD4 counts of <200/μL cells and in the first five years of HAART follow-up is recommended to reduce visual impairment and/or blindness.
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Zhi-Chun Zhao, Ying Zhou, Gang Tan, Juan Li
Abstract:
In recent years, people have become increasingly attentive to light pollution influences on their eyes. In the visible spectrum, short-wave blue light with wavelength between 415 nm and 455 nm is closely related to eye light damage. This high energy blue light passes through the cornea and lens to the retina causing diseases such as dry eye, cataract, age-related macular degeneration, even stimulating the brain, inhibiting melatonin secretion, and enhancing adrenocortical hormone production, which will destroy the hormonal balance and directly affect sleep quality. Therefore, the effect of Blu-rays on ocular is becoming an important concern for the future. We describe blue light’s effects on eye tissues, summarize the research on eye injury and its physical prevention and medical treatment.
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Ji Jin, Lei Chen, Gao-Qin Liu, Pei-Rong Lu
Abstract:
AIM: To analyze the retinal proteomes with and without conbercept treatments in mice with oxygen-induced retinopathy (OIR) and identify proteins involved in the molecular mechanisms mediated by conbercept. METHODS: OIR was induced in fifty-six C57BL/6J mouse pups and randomly divided into four groups. Group 1: Normal17 (n=7), mice without OIR and treated with normal air. Group 2: OIR12/EXP1 (n=14), mice received 75% oxygen from postnatal day (P) 7 to 12. Group 3: OIR17/Control (n=14), mice received 75% oxygen from P7 to P12 and then normal air to P17. Group 4: Lang17/EXP2 (n=21), mice received 75% oxygen from P7 to P12 with intravitreal injection of 1 μL conbercept at the concentration of 10 mg/mL at P12, and then normal air from P12 to P17. Liquid Chromatography-Mass Spectrometry (LC-MS)/MS data were reviewed to find proteins that were up-regulated after the conbercept treatment. Gene ontology (GO) analysis was performed of conbercept-mediated changes in proteins involved in single-organism processes, biological regulation, cellular processes, immune responses, metabolic processes, locomotion and multiple-organism processes. RESULTS: Conbercept induced a reversal of hypoxia-inducible factor 1 signaling pathway as revealed by the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis and also induced down-regulation of proteins involved in blood coagulation and fibrin clot formation as demonstrated by the Database for Annotation, Visualization and Integrated Discovery (DAVID) and the stimulation of interferon genes studies. These appear to be risk factors of retinal fibrosis. Additional conbercept-specific fibrosis risk factors were also identified and may serve as therapeutic targets for fibrosis. CONCLUSION: Our studies reveal that many novel proteins are differentially regulated by conbercept. The new insights may warrant a valuable resource for conbercept treatment.
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Xi-Teng Chen, Hui Huang, Yan-Hua Chen, Li-Jie Dong, Xiao-Rong Li, Xiao-Min Zhang
Abstract:
AIM:To identify the genetic defects in a Chinese family with achromatopsia.METHODS:A 2.5-year-old boy, who displayed nystagmus, photophobia, and hyperopia since early infancy, was clinically evaluated. To further confirm and localize the causative mutations in this family, targeted region capture and next-generation sequencing of candidate genes, such as CNGA3, CNGB3, GNAT2, PDE6C, and PDE6H were performed using a custom-made capture array.RESULTS:Slit-lamp examination showed no specific findings in the anterior segments. The optic discs and maculae were normal on fundoscopy. The unaffected family members reported no ocular complaints. Clinical signs and symptoms were consistent with a clinical impression of autosomal recessive achromatopsia. The results of sequence analysis revealed two novel missense mutations in CNGA3, c.633T>A (p.D211E) and c.1006G>T (p.V336F), with an autosomal recessive mode of inheritance.CONCLUSION: Genetic analysis of a Chinese family confirmed the clinical diagnosis of achromatopsia. Two novel mutations were identified in CNGA3, which extended the mutation spectrum of this disorder.
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Abstract:
Simulation can be defined as malingering, or sometimes functional visual loss (FVL). It manifests as either simulating an ophthalmic disease (positive simulation), or denial of ophthalmic disease (negative simulation). Conscious behavior and compensation or indemnity claims are prominent features of simulation. Since some authors suggest that this is a manifestation of underlying psychopathology, even conversion is included in this context. In today’s world, every ophthalmologist can face with simulation of ophthalmic disease or disorder. In case of simulation suspect, the physician’s responsibility is to prove the simulation considering the disease/disorder first, and simulation as an exclusion. In simulation examinations, the physician should be firm and smart to select appropriate test(s) to convince not only the subject, but also the judge in case of indemnity or compensation trials. Almost all ophthalmic sensory and motor functions including visual acuity, visual field, color vision and night vision can be the subject of simulation. Examiner must be skillful in selecting the most appropriate test. Apart from those in the literature, we included all kinds of simulation in ophthalmology. In addition, simulation examination techniques, such as, use of optical coherence tomography, frequency doubling perimetry (FDP), and modified polarization tests were also included. In this review, we made a thorough literature search, and added our experiences to give the readers up-to-date information on malingering or simulation in ophthalmology.
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Ping-Ting Zhao, Ling-Jun Zhang, Hui Shao, Ling-Ling Bai, Bo Yu, Chang Su, Li-Jie Dong, Xun Liu, Xiao-Rong Li, Xiao-Min Zhang
Abstract:
AIM: To test the therapeutic effects of delayed treatment of mesenchymal stem cells (MSCs) in recurrent experimental autoimmune uveitis (rEAU). METHODS: The efficacy of different regimens of MSC administration in rEAU were tested by evaluation of clinical and pathological intraocular inflammation, as well as retinal structural and functional integrity using optical coherence tomography (OCT) and electroretinogram (ERG). The retinal sections were also immunostained with antibodies to glial fibrillary acidic protein (GFAP) and rhodopsin (RHO). RESULTS: Delayed treatment of MSCs effectively alleviated the severity of intraocular inflammation with relative intact of outer retinal structure and function. Moreover, double therapies with longer interval led to an even better clinical evaluation, as well as a trend of decrease in relapse and amelioration of retinal function. MSC therapies also effectively reduced GFAP expression and increased RHO expression in the retina. CONCLUSION: MSC administration can effectively treat developed diseases of rEAU, and multiple therapies can provide additional therapeutic benefits.
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Li-Fei Yuan, Guang-Da Li, Xin-Jun Ren, Hong Nian, Xiao-Rong Li, Xiao-Min Zhang
Abstract:
AIM:To determine the effects of rapamycin on experimental autoimmune uveoretinitis (EAU) and investigate of role of rapamycin on T cell subsets in the disease. METHODS:EAU was induced in rats using peptides 1169 to 1191 of the interphotoreceptor binding protein (IRBP). Rapamycin (0.2 mg/kg/d) was administrated by intraperitoneal injection for a consecutive 7d after immunization. Th1/Th2/Th17 cytokines, TGF-β1, and IL-6 produced by lymphocyteswere measured by ELISA, while Th17 cells and CD4+CD25+ regulatory T cells (Tregs) from rat spleen were detected by flow cytometry. RESULTS: Intraperitoneal treatment immediately after immunization dramatically ameliorated the clinical course of EAU. Clinical responses were associated with reduced retinal inflammatory cell infiltration and tissue destruction. Rapamycin induced suppression of Th1/Th2/Th17 cytokines, including IFN-γ, IL-2, IL-17, IL-4, and IL-10 release from T lymphocytes of EAU rats, in vitro. Rapamycin also significantly increased TGF-β1 production but had no effect on IL-6 productionof T lymphocytes from EAU rats in vitro. Furthermore, rapamycin decreased the ratio of Th17 cells/CD4+T cells and upregulated Tregs in EAU, as detected by flow cytometry. CONCLUSION: Rapamycin effectively interferes with T cell mediated autoimmune uveitis by inhibiting antigen-specific T cell functions and enhancing Tregs in EAU. Rapamycin is a promising new alternative as an adjunct corticosteroid-sparing agent for treating uveitis.
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Abstract:
AIM: To report various ocular lesions caused by accidental instillation of superglue.METHODS: Three cases of ocular injuries are described in children aged 6 years, 3 years and 8 months, following accidental instillation of superglue in the eye.RESULTS: In the first case there was sticking of eyelashes in the medial 1/3 of eyelids in both eyes. In the second case sticking of eye lashes was present in the lateral 1/3 of eyelids in the left eye. In the third case, superglue was present on the right cheek, above the right ear and sticking of eyelids in medial 1/3 in right eye. The eyelids were separated by pulling the lid margins with fingers in the first case and later on superglue was removed by trimming the eyelashes; and by direct trimming the eyelashes in second and third cases. There was no injury to other structures of anterior segment in the first two cases. However, removal of the superglue on the cornea resulted in corneal abrasion in the third case which healed with medical treatment and patching of the right eye.CONCLUSION: Accidental instillation of superglue is possible because of the appearance of the tube like eye ointment tube. Immediate medical aid will prevent ocular morbidity.
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Yang-Qing Huang, He Huang, Rong-Zhi Huang
Abstract:
AIM:To introduce a new near-vision chart for children aged 3-5 years old and its clinical applications.METHODS:The new near-vision chart which combined the Bailey-Lovie layout with a newly devised set of symmetry symbols was designed based on Weber-Fechner law. It consists of 15 rows of symmetry symbols, corresponding to a visual acuity range from 1.3 to 0.1 logMAR. The optotypes were red against a white background and were specially shaped four basic geometric symbols:circle, square, triangle，and cross, which matched the preschool children''s cognitive level. A regular geometric progression of the optotype sizes and distribution was employed to arrange in 15 lines. The progression rate of the optotype size between two lines was 1.2589 and two smaller groups of optotypes ranging from 0.7 to -0.1 logMAR were included for repetitive testing. A near visual acuity was recorded in logMAR or decimal, and the testing distance was 25 cm.RESULTS:This new near-vision chart with pediatric acuity test optotypes which consists of 4 different symbols (triangle, square, cross, and circle) met the national and international eye chart design guidelines. When performing the near visual acuity assessment in preschoolers (3-5 years old). It overcame an inability to recognize the letters of the alphabet and difficulties in designating the direction of black abstract symbols such as the tumbling ''E'' or Landolt ''C'', which the subjects were prone to lose interest in. Near vision may be recorded in different notations:decimal acuity and logMAR. These two notations can be easily converted each other in the new near-vision chart. The measurements of this new chart not only showed a significant correlation and a good consistency with the Chinese national standard logarithmic near-vision chart (r=0.932, P<0.01), but also indicated good test-retest reliability (89% of retest scores were within 0.1 logMAR units of the initial test score) and a high response rate.CONCLUSION:The results of this study support the validity and reliability of near visual acuity measurements using the new near-vision chart in children aged 3-5y over a wide range of visual acuities, and the new eye chart was especially suitable for the detection of amblyopia risk factors and low vision examination in children (3-5y of age). It can be applied in routine clinical practice.
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Ali Ihsan Incesu, Güng?r Sobac?
Abstract:
Simulation can be defined as malingering, or sometimes functional visual loss (FVL). It manifests as either simulating an ophthalmic disease (positive simulation), or denial of ophthalmic disease (negative simulation). Conscious behavior and compensation or indemnity claims are prominent features of simulation. Since some authors suggest that this is a manifestation of underlying psychopathology, even conversion is included in this context. In today's world, every ophthalmologist can face with simulation of ophthalmic disease or disorder. In case of simulation suspect, the physician's responsibility is to prove the simulation considering the disease/disorder first, and simulation as an exclusion. In simulation examinations, the physician should be firm and smart to select appropriate test(s) to convince not only the subject, but also the judge in case of indemnity or compensation trials. Almost all ophthalmic sensory and motor functions including visual acuity, visual field, color vision and night vision can be the subject of simulation. Examiner must be skillful in selecting the most appropriate test. Apart from those in the literature, we included all kinds of simulation in ophthalmology. In addition, simulation examination techniques, such as, use of OCT (optical coherence tomography), frequency doubling perimetry (FDP), and modified polarization tests were also included. In this review, we made a thorough literature search, and added our experiences to give the readers up-to-date information on malingering or simulation in ophthalmology.
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Blake F. Webb, Jadon R. Webb, Mary C. Schroeder, Carol S. North
Abstract:
AIM: To estimate the prevalence and risk factors for vitreous floaters in the general population.METHODS: An electronic survey was administered through a smartphone app asking various demographic and health questions, including whether users experience floaters in their field of vision. Multivariate logistic regression analysis was used to determine risk factors.RESULTS:A total of 603 individuals completed the survey, with 76% reporting that they see floaters, and 33% reporting that floaters caused noticeable impairment in vision. Myopes were 3.5 times more likely (P=0.0004), and hyperopes 4.4 times more likely (P=0.0069) to report moderate to severe floaters compared to those with normal vision. Floater prevalence was not significantly affected by respondent age, race, gender, and eye color.CONCLUSION:Vitreous floaters were found to be a very common phenomenon in this non-clinical general population sample, and more likely to be impairing in myopes and hyperopes.
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Bora Yüksel, Sultan Kaya ünsal, Sevgi Onat
Abstract:
AIM: To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft. METHODS: A prospective randomised clinical trial was carried out in 58 eyes of 58 patients operated for primary nasal pterygium. Autologous conjunctival graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision. In 29 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive (Beriplast P) and in 29 eyes with 8-0 Virgin silk sutures. The Mann-Whitney U test was used for statistical analysis. Postoperative patient discomfort (pain, stinging, watering) and biomicroscopic findings (hyperemia, edema) were graded. Patients were followed up at least for six months. RESULTS: Subconjunctival hemorrhage occured under the graft in one patient in group 1. In seven cases of group 2, sutures were removed at the 15th day because of granulomatous tissue reaction. Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in one case of group 1, and 2 cases of group 2. Average surgery cost was higher (P<0.05) and surgery time was shorter (P<0.05) in fibrin group. CONCLUSION: Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.
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Abstract:
Photobiomodulation (PBM), also known as low level laser therapy, has recently risen to the attention of the ophthalmology community as a promising new approach to treat a variety of retinal conditions including age-related macular degeneration, retinopathy of prematurity, diabetic retinopathy, Leber’s hereditary optic neuropathy, amblyopia, methanol-induced retinal damage, and possibly others. This review evaluates the existing research pertaining to PBM applications in the retina, with a focus on the mechanisms of action and clinical outcomes. All available literature until April 2015 was reviewed using PubMed and the following keywords: “photobiomodulation AND retina”, “low level light therapy AND retina”, “low level laser therapy AND retina”, and “FR/NIR therapy AND retina”. In addition, the relevant references listed within the papers identified through PubMed were incorporated. The literature supports the conclusion that the low-cost and non-invasive nature of PBM, coupled with the first promising clinical reports and the numerous preclinical-studies in animal models, make PBM well-poised to become an important player in the treatment of a wide range of retinal disorders. Nevertheless, large-scale clinical trials will be necessary to establish the PBM therapeutic ranges for the various retinal diseases, as well as to gain a deeper understanding of its mechanisms of action.
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Wen-Bin Huang, Qian Fan, Xiu-Lan Zhang
Abstract:
Glaucoma is one of the leading causes of visual impairment and blindness. Improved knowledge of the pathogenesis of this disease has allowed the exploration of new therapeutic methods. In general, elevated intraocular pressure (IOP), oxidative stress, and vascular insufficiency are accepted as the major risk factors for the progression of glaucoma. Many natural compounds have been found beneficial for glaucoma. Nutritional therapies are now emerging as potentially effective in glaucomatous therapy. One nutritional supplement with potential therapeutic value is cod liver oil, a dietary supplement that contains vitamin A and omega-3 polyunsaturated fatty acids (PUFAs). Vitamin A is important for preserving normal vision and it is a well-known antioxidant that prevents the oxidative damage that contributes to the etiology and progression of glaucoma. Vitamin A is also a crucial factor for maintaining the integrity of conjunctival and corneal ocular surfaces, and preventing the impairment of ocular epithelium caused by topical antiglaucomatous drugs. Omega-3 fatty acids are beneficial for glaucoma patients as they decrease IOP, increase ocular blood flow, and improve optic neuroprotective function. In this article, we propose that cod liver oil, as a combination of vitamin A and omega-3 fatty acids, should be beneficial for the treatment of glaucoma. However, further studies are needed to explore the relationship between cod liver oil and glaucoma.
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Jun Yi, Jun Yun, Zhi-Kui Li, Chang-Tai Xu, Bo-Rong Pan
Abstract:
· Congenital cataract is a crystallin severe blinding disease and genetic factors in disease development are important. Crystallin growth is under a combination of genes and their products in time and space to complete the coordination role of the guidance. Congenital cataract-related genes, included crystallin protein gene (CRYAA, CRYAB, CRYBA1/A3, CRYBA4, CRYBB1, CRYBB2, CRYBB3, CRYGC, CRYGD, CRYGS), gap junction channel protein gene (GJA1, GJA3, GJA8), membrane protein gene (GJA3, GJA8, MIP, LIM2), cytoskeletal protein gene (BF-SP2), transcription factor genes (HSF4, MAF, PITX3, PAX6), ferritin light chain gene (FTL), fibroblast growth factor (FGF) and so on. Currently, there are about 39 genetic loci isolated to which primary cataracts have been mapped, although the number is constantly increasing and depends to some extent on definition. We summarized the recent advances on epidemiology and genetic locations of congenital cataract in this review.
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Juan-Juan Li, Yun-Peng Li, Zhu-Lin Hu
Abstract:
We describe the successful treatment in a patient with bilateral congenital aniridia and cataract by insertion of capsular tension rings and IOL.
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Abstract:
AIM: To compare the efficacy for preventing exposure keratopathy of three forms of eye care (artificial tear, moist chamber and polyethylene covers) for intensive care patients. METHODS: Eighty-four patients in Intensive Care Unit (ICU) were randomized to three treatment groups, including artificial tears group, moist chambers group and polyethylene film group. Patients of artificial tear group received two drops of carboxymethylcellulose drops to each eye every 2 hours. The moist chambers and the polyethylene were changed every 12 hours or as needed if they became unclean or torn. The corneal fluorescein stains were performed daily. RESULTS: No of 28 patients (0%) in the polyethylene group and one of the 27 patients (3.70%) in the moist chamber group had exposure keratopathy, compared to 8 of the 29 patients (27.59%) in the artificial tear group. There were statistical significance between the artificial tear group and the moist chamber group (P=0.02), and the artificial tear group and the polyethylene group (P =0.003). The time on eye care every day of the artificial tear group, the moist chamber group and the polyethylene group was 26.69±2.39 minutes, 35.33±2.63 minutes and 7.48±0.87 minutes, respectively. The eye care of the polyethylene group were statistically more time-save than that of the artificial tear group (P<0.001) and the moist chamber group (P<0.001). CONCLUSION: Polyethylene covers are more effective and more time-saving in reducing the incidence of corneal damage in intensive care patients
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