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. IJO’s JCR IF in 2023 is 1.9, Five-year Impact Factor is 1.8, CiteScore in 2023 is 2.5. IJO was established in 2008, with editorial office in Xi’an, China. It is a monthly publication and accept contribations from all over the world, both basic and Chinical research.
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Qian Ling, Zi-Song Xu, Yan-Mei Zeng, Qi Hong, Xian-Zhe Qian, Jin-Yu Hu, Chong-Gang Pei, Hong Wei, Jie Zou, Cheng Chen, Xiao-Yu Wang, Xu Chen, Zhen-Kai Wu, Yi Shao
2025,18(1):1-8, DOI: 10.18240/ijo.2025.01.01
Abstract:
AIM: To assess the possibility of using different large language models (LLMs) in ocular surface diseases by selecting five different LLMS to test their accuracy in answering specialized questions related to ocular surface diseases: ChatGPT-4, ChatGPT-3.5, Claude 2, PaLM2, and SenseNova. METHODS: A group of experienced ophthalmology professors were asked to develop a 100-question single-choice question on ocular surface diseases designed to assess the performance of LLMs and human participants in answering ophthalmology specialty exam questions. The exam includes questions on the following topics: keratitis disease (20 questions), keratoconus, keratomalaciac, corneal dystrophy, corneal degeneration, erosive corneal ulcers, and corneal lesions associated with systemic diseases (20 questions), conjunctivitis disease (20 questions), trachoma, pterygoid and conjunctival tumor diseases (20 questions), and dry eye disease (20 questions). Then the total score of each LLMs and compared their mean score, mean correlation, variance, and confidence were calculated. RESULTS: GPT-4 exhibited the highest performance in terms of LLMs. Comparing the average scores of the LLMs group with the four human groups, chief physician, attending physician, regular trainee, and graduate student, it was found that except for ChatGPT-4, the total score of the rest of the LLMs is lower than that of the graduate student group, which had the lowest score in the human group. Both ChatGPT-4 and PaLM2 were more likely to give exact and correct answers, giving very little chance of an incorrect answer. ChatGPT-4 showed higher credibility when answering questions, with a success rate of 59%, but gave the wrong answer to the question 28% of the time. CONCLUSION: GPT-4 model exhibits excellent performance in both answer relevance and confidence. PaLM2 shows a positive correlation (up to 0.8) in terms of answer accuracy during the exam. In terms of answer confidence, PaLM2 is second only to GPT4 and surpasses Claude 2, SenseNova, and GPT-3.5. Despite the fact that ocular surface disease is a highly specialized discipline, GPT-4 still exhibits superior performance, suggesting that its potential and ability to be applied in this field is enormous, perhaps with the potential to be a valuable resource for medical students and clinicians in the future.
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Fumiaki Higashijima, Makoto Hatano, Manami Ohta, Tadahiko Ogata, Takuya Yoshimoto, Atsushige Ashimori, Makiko Wakuta, Kazuhiro Kimura
2025,18(1):9-14, DOI: 10.18240/ijo.2025.01.02
Abstract:
AIM: To measure the optimal anterior chamber pressure (ACP) for safe phacoemulsification using a new tube chamber system with internal pressure measurement function in the porcine eye. METHODS: The 20-gauge and 21-gauge straight tips with yellow and orange sleeves, respectively, were covered by a test chamber combined with a pressure sensor for measuring ACP. This was measured for 20s from 10s after starting aspiration in the linear mode using vacuum levels of 200 and 150 mm Hg with a 20-gauge tip, and 300 and 250 mm Hg with a 21-gauge tip. Using a porcine eye, a pressure sensor fixed with a 0.9 mm corneal incision measured ACP. For the posterior capsule contact assay, porcine eyes were treated as described above, and the ultrasonic needle tip was held at the height of the iris and aspirated for 30s in linear mode at a vacuum of 200 and 150 mm Hg for the 20-gauge tip, and 300 and 250 mm Hg for the 21-gauge tip. The bottle height at which the posterior capsule accidentally contacted the ultrasonic tip was recorded, and the estimated ACP was calculated. RESULTS: The internal pressure of the new tube chamber system and ACP from the porcine eye closely matched proportional changes at vacuum levels of 200 and 150 mm Hg with 20-gauge tips. Similarly, proportional changes at vacuum levels of 300 and 250 mm Hg with the 21-gauge tip were nearly equal. The bottle height at which the posterior capsule contacted with the tip and estimated ACP were 57.5±12.6 cm (20.2±7.9 mm Hg) at 200 mm Hg with a 20-gauge tip, 35.0±10.0 cm (16.6±6.3 mm Hg) at 150 mm Hg with a 20-gauge tip, 47.5±12.6 cm (18.7±8.7 mm Hg) at 300 mm Hg with a 21-gauge tip, and 32.5±5.0 cm (15.7±3.5 mm Hg) at 250 mm Hg with a 21-gauge tip. CONCLUSION: A comprehensive understanding of this chamber system’s characteristics and usage can resolve anterior chamber instability caused by changing preoperative settings on the phaco machine.
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Hui-Min Zhong, Bing-Qiao Shen, Yu-Hong Chen, Xiao-Huan Zhao, Xiao-Xu Huang, Min-Wen Zhou, Xiao-Dong Sun
2025,18(1):15-27, DOI: 10.18240/ijo.2025.01.03
Abstract:
AIM: To investigate whether interleukin-17A (IL-17A) gets involved in the mechanisms of inflammation-related retinal pigment epithelium (RPE) cells injury and its significance in age-related macular degeneration (AMD). RESULTS: In the scenario of NaIO3 stimulation, RPE cells obviously tended to degenerate. Simultaneously proliferation and activation of retinal microglia was confirmed in NaIO3-stimulated mice, whereas such effects induced by NaIO3 were significantly ameliorated with IL-17A NAb intervention or in IL-17A-/- mice. In addition, IL-17A promoted the proliferation and activation of microglia as well as oxidative damage and the secretion of inflammatory cytokines alongside NaIO3-induced damage in RPE cells in vivo and ex vivo. Meanwhile, the extracellular signal-regulated kinase (ERK) signaling pathway was shown to be participated in the regulation of NaIO3-induced RPE cells injury mediated by IL-17A in vivo and ex vivo, as IL-17A-induced inflammatory cytokines release in the NaIO3 model was alleviated after blocking the ERK pathway. CONCLUSION: IL-17A probably promotes the NaIO3-induced RPE cells injury through exacerbating inflammation in terms of retinal microglia activation and inflammatory cytokines release via ERK signaling pathway. Inhibition of IL-17A may be a new potential target for dry AMD treatment.
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Na-Na Meng, Lei-Zhou Xia, Yi-Qing Gong, Pei-Rong Lu
2025,18(1):28-38, DOI: 10.18240/ijo.2025.01.04
Abstract:
AIM: To test the effect of autophagy on inflammatory damage resulting from oxidative stress in adult retinal pigment epithelial cell line (ARPE-19). METHODS: ARPE-19 cells were pretreated with 200 and 600 µmol/L hydrogen peroxide (H2O2) at various time intervals. The changes of cell morphology, cell viability, reactive oxygen species (ROS) level, autophagic activity, and the inflammatory cytokines (TNFα, IL-6, and TGFβ) were measured at baseline and after treatment with autophagy inducer rapamycin (Rapa) and suppressor wortmannin (Wort) or shATG5. RESULTS: The levels of ROS, cytokines (TNFα, IL-6, and TGFβ), and autophagic activity were significantly increased in ARPE-19 cells after pretreated with H2O2 (all P<0.05) and IL-10 was significantly decreased (P<0.05). By upregulating autophagy, Rapa significantly reduced oxidative stress-induced secretion of pro-inflammatory factors (TNFα and IL-6) and ROS (all P<0.05), yet elevated the production of TGFβ (P<0.05). In contrast, suppression of autophagy through Wort or ATG5 knockdown reduced cell viability, increased cell apoptotic rate, and exacerbated the generation of ROS and inflammatory cytokines (TNFα, IL-6, and TGFβ; all P<0.05). CONCLUSION: Autophagy demonstrates a protective effect on ARPE-19 cell through mitigating oxidative damage and oxidative stress-induced inflammatory response. Regulation of autophagy may be a potential way for age-related macular degeneration.
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2025,18(1):39-50, DOI: 10.18240/ijo.2025.01.05
Abstract:
AIM: To explore the neuroprotective effects of high mobility group box 2 (HMGB2) knockdown on retinal ganglion cells (RGCs) in the retinal ischemia-reperfusion injury (RIRI). METHODS: Oxygen-glucose deprivation (OGD)-injured RGCs from postnatal three-day C57BL/6 mice pups and high intraocular pressure (IOP)-induced RIRI mice were used as cellular and animal models of RIRI. The expression of HMGB2 in the retina of RIRI mice and OGD-injured RGCs was detected through reverse transcription-polymerase chain reaction (RT-qPCR) and Western blotting. The effects of HMGB2 silencing on the morphological changes, RGCs survival, and cell apoptosis in mouse retinal tissues were observed through H&E staining, immunofluorescence staining with RNA-binding protein with multiple splicing (RBPMS) antibody, and TUNEL staining, respectively. RGC viability and apoptosis were examined by CCK-8 and flow cytometry assays. The levels of proteins associated with NOD-like receptor thermal protein domain associated protein 3 (NLRP3)-mediated pyroptosis [NLRP3, Caspase-1, GSDMD-N, interleukin (IL)-1β, IL-18] in vivo and in vitro were measured by Western blotting. RESULTS: HMGB2 protein and NLRP3 were upregulated in the retina of RIRI mice and OGD-injured RGCs (P<0.001). The retina was edematous, accompanied by disorganized cell arrangement and decreased thickness of all layers, and obvious vacuoles in ganglion cell layer. HMGB2 silencing alleviated the reduction in total retinal thickness and the severity of retinal tissue damage as well as suppressed RGC loss and retinal cell apoptosis in RIRI mice. OGD-induced RGC apoptosis was ameliorated after downregulation of HMGB2 in vitro. Intravitreal injection of the AAV-sh-HMGB2 and si-HMGB2 resulted in significantly decrease of NLRP3, Caspase-1, GSDMD-N, IL-1β, and IL-18 protein levels in the retinal tissues of RIRI mice and OGD-injured RGCs, respectively (all P<0.001). CONCLUSION: HMGB2 knockdown protects against RGC apoptosis and pyroptosis after RIRI through suppressing NLRP3 inflammasome activation.
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Yi Shao, Jian-Min Ma, Xiao-Ming Huang, Expert Workgroup of Guidelines for the use of imaging equipment in orbital diseases (2024), 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, Chinese Ophthalmic Imaging Study Groups
2025,18(1):51-66, DOI: 10.18240/ijo.2025.01.06
Abstract:
Orbital disorders include conditions originating from the orbital bones, surrounding tissues, and post-orbital septum. They also include systemic ailments affecting the orbit. Different clinical symptoms make up the complex range of orbital disorders. Because these disorders mostly impact the orbital area instead of the intraocular compartment, there is little diagnostic usefulness for typical ophthalmic visual tests. As such, the vital instruments for diagnosing and evaluating orbital illnesses have become ophthalmic imaging modalities, including ocular ultrasonography (B-scan), computed tomography (CT), and magnetic resonance imaging (MRI). One way to improve the precision and promptness of diagnosing orbital diseases is to standardize the functioning of widely used imaging equipment and define the radiological features of orbital abnormalities. Such programs are crucial for the care of patients with orbital disorders since they considerably reduce the number of misdiagnoses and missed diagnoses in these individuals. The underlying concepts, operational techniques, and normal and pathological imaging findings associated with common diagnostic tools for orbital illnesses are all thoroughly reviewed in this guideline. The objective is to improve primary healthcare settings’ diagnostic competence in the field of orbital pathology and to standardize procedures for diagnosing orbital disorders.
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Hamed Soltan-Dehghan, Abdollah Farzaneh, Hassan Hashemi, Payam Nabovati, Mehdi Khabazkhoob
2025,18(1):67-73, DOI: 10.18240/ijo.2025.01.07
Abstract:
AIM: To identify topographic determinants of the anterior chamber angle (ACA) in patients with keratoconus (KCN). METHODS: Four hundred and ten eyes of 294 patients with KCN were recruited for this study. First, complete ocular examinations were performed for all patients, including visual acuity measurement, refraction, and slit-lamp biomicroscopy. Then, all participants underwent corneal imaging by the Oculus Pentacam HR. RESULTS: The mean age of the participants was 32.40± 8.52y (15-60y) and 69.5% of them were male. The mean ACA was 38.47°±5.75° (range: 14.40° to 56.50°) in the whole sample, 38.24°±6.00° in males, and 38.98°±5.11° in females (P=0.447). The mean ACA was significantly different among different groups of cone morphology, as patients with nipple cones showed the lowest mean ACA. Moreover, there were statistically significant differences in the mean ACA among different groups of cone locations, with patients having central cones exhibiting the lowest mean ACA (P<0.001). Anterior and posterior Q values were significantly, directly correlated with ACA (anterior Q: r=0.122, P=0.014, posterior Q: r=0.192, P<0.001). CONCLUSION: This study provides critical insights into the risk factors for ACA narrowing in KCN patients, which is essential for planning intraocular surgeries. Patients with nipple and central cones exhibited the most significant ACA narrowing. Additionally, more negative Q-values are associated with increased ACA narrowing, highlighting the need for targeted diagnostic and therapeutic strategies.
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Xu-Hao Chen, Ying Hong, Xiang-Han Ke, Si-Jia Song, Yu-Jie Cen, Chun Zhang
2025,18(1):74-78, DOI: 10.18240/ijo.2025.01.08
Abstract:
AIM: To investigate the influence of postoperative intraocular lens (IOL) positions on the accuracy of cataract surgery and examine the predictive factors of postoperative biometry prediction errors using the Barrett Universal II (BUII) IOL formula for calculation. METHODS: The prospective study included patients who had undergone cataract surgery performed by a single surgeon from June 2020 to April 2022. The collected data included the best-corrected visual acuity (BCVA), corneal curvature, preoperative and postoperative central anterior chamber depths (ACD), axial length (AXL), IOL power, and refractive error. BUII formula was used to calculate the IOL power. The mean absolute error (MAE) was calculated, and all the participants were divided into two groups accordingly. Independent t-tests were applied to compare the variables between groups. Logistic regression analysis was used to analyze the influence of age, AXL, corneal curvature, and preoperative and postoperative ACD on MAE. RESULTS: A total of 261 patients were enrolled. The 243 (93.1%) and 18 (6.9%) had postoperative MAE<1 and >1 D, respectively. The number of females was higher in patients with MAE>1 D (χ2 = 3.833, P=0.039). The postoperative BCVA (logMAR) of patients with MAE >1 D was significantly worse (t=-2.448; P=0.025). After adjusting for gender in the logistic model, the risk of postoperative refractive errors was higher in patients with a shallow postoperative anterior chamber [odds ratio=0.346; 95% confidence interval (CI): 0.164, 0.730, P=0.005]. CONCLUSION: Risk factors for biometry prediction error after cataract surgery include the patient’s sex and postoperative ACD. Patients with a shallow postoperative anterior chamber are prone to have refractive errors.
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Jia-Ru Liu, Andrei-Alexandru Szigiato, Paul Harasymowycz
2025,18(1):79-85, DOI: 10.18240/ijo.2025.01.09
Abstract:
AIM: To assess visual outcomes and satisfaction of a non-diffractive extended depth of focus (EDOF) intraocular lens (IOL) in individuals with ocular hypertension (OHT) and well-controlled mild glaucoma undergoing cataract surgery. METHODS: An investigator-initiated, single-center, prospective, interventional, noncomparative study conducted in Montreal, Canada. The study enrolled 31 patients (55 eyes) with OHT or mild glaucoma who received a non-diffractive EDOF IOL (Acrysof IQ Vivity). Participants underwent sequential cataract surgery with the Vivity IOL. Follow-up evaluations occurred at 1d, 1, and 3mo postoperatively, assessing uncorrected distance, intermediate, and near visual acuity. Questionnaires (QUVID: Questionnaire for visual disturbances and IOLSAT: Intraocular lens satisfaction) were administered pre and post-operatively to measure visual disturbances and spectacle independence in various lighting. Safety parameters included intraocular pressure (IOP), glaucoma medications, spherical equivalence, mean deviation and pattern standard deviation or square root of lost variance on Octopus visual field. RESULTS: At 1 and 3mo postoperatively, significant improvements were observed in uncorrected distance and intermediate visual acuity. Spectacle independence was enhanced for distance and intermediate vision, especially in bright light settings. Spectacle-free intermediate vision was improved even in dim lighting. Visual disturbances, particularly glare symptoms, were reduced, and there was a notable decrease in IOP and glaucoma medication burden at 3mo. There was more hazy vision postoperatively with no impact on visual acuity and visual satisfaction. CONCLUSION: The non-diffractive EDOF lens improves distance and intermediate spectacle-free visual function in patients with OHT and well-controlled glaucoma. The findings highlight significant improvements in visual acuity, reduced glare, enhanced spectacle independence, and improved visual performance in different lighting conditions.
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Caroline Bormann, Catharina Busch, Matus Rehak, Christian Thomas Scharenberg, Focke Ziemssen, Jan Darius Unterlauft
2025,18(1):86-93, DOI: 10.18240/ijo.2025.01.10
Abstract:
AIM: To evaluate the short-term efficacy of XEN45 Gel Stent (XEN) implantation for primary open angle glaucoma (POAG) and pseudoexfoliation (PEX) glaucoma across two university eye clinics, aiming to assess the impact of varying center-specific protocols during the first postoperative year. METHODS: We retrospectively examined 282 patients (183 in center 1, 99 in center 2), who underwent XEN microstent implantation for uncontrolled POAG or PEX glaucoma. Parameters including intraocular pressure (IOP), IOP-lowering medication count, best corrected visual acuity (BCVA), and postoperative complications were evaluated over 12mo. RESULTS: Post-implantation, center 1 reported a mean IOP reduction from 25.3±7.4 to 14.1±4.7 mm Hg (P<0.01) and a decrease in IOP-lowering medications from 3.2±1.2 to 1.0±1.3 (P<0.01). Center 2 observed a similar reduction from 24.4±6.5 to 15.1±5.5 mm Hg (P<0.01) and medication decrease from 3.0±1.1 to 1.2±1.0 (P<0.01). BCVA remained stable in both cohorts. The most common complications were hypotony (center 1: 32; center 2: 20) and choroidal detachment (center 1: 22, center 2: 15), with nearly identical needling rates (40% in center 1, 41% in center 2). CONCLUSION: XEN implantation yields consistent reductions in IOP and medication use across different centers using comparable surgical and postoperative treatment regime. These findings underscore XEN’s short-term effectiveness and suggest standardizable outcomes regardless of exact surgical procedure or treatment differences.
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Jia-Yin Qin, Yan Liu, Tao Wang
2025,18(1):94-102, DOI: 10.18240/ijo.2025.01.11
Abstract:
AIM: To evaluate the efficacy and safety of microcatheter-assisted 360-degree trabeculotomy combined with trabeculectomy (MATT-Trab) for treating refractory glaucoma. METHODS: Patients with refractory glaucoma who underwent MATT-Trab were retrospectively examined. Efficacy indicators for research statistics included the intraocular pressure (IOP) level, degree of decrease, changes in medication dosage, and success rate. Safety indicators included the best-corrected visual acuity and incidence of complications. RESULTS: This study comprised 31 patients, including 11 males and 20 females, with ages ranging from 8mo to 67y (mean age: 29.40±22.10y). The average postoperative IOP at 1d, 1wk, 1mo, 3mo, 6mo, 1y, and the last follow-up was significantly lower than the average preoperative IOP (31.33±9.24 mm Hg, P<0.05). The average number of postoperative medications at 1y was 0.48±1.51, which was significantly reduced compared to that used preoperatively (3.77±0.99, P=0.00). The absolute and qualified success rates were 45.16% and 83.87%, respectively. Visual acuity exhibited no statistically significant difference between the postoperative and preoperative follow-up time points, except for the first day after surgery. The most common postoperative complications were anterior chamber hemorrhage (25 cases, 86.21%) and high IOP (10 cases, 34.48%). CONCLUSION: Our results indicate that MATT-Trab is effective and safe for treating refractory glaucoma.
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Inês Costa, Ana Carvalho, Helton Andrade, Bruno Pereira, Pedro Camacho
2025,18(1):103-110, DOI: 10.18240/ijo.2025.01.12
Abstract:
AIM: To quantify and compare longitudinal thickness changes of the ganglion cell complex (GCC) and the choroid in patients with different patterns of age-related macular degeneration (AMD) progression. METHODS: Retrospective cohort analysis of anonymized data from participants aged 50y or more and diagnosed with early/intermediate AMD in at least one eye (with no evidence of advanced AMD). A total of 64 participants were included from the Instituto de Retina de Lisboa (IRL) study (IPL/2022/MetAllAMD_ESTeSL) and divided into 4 groups according to the Rotterdam classification for AMD. Spectral domain optical coherence tomography (SD-OCT) was used to assess and quantify GCC and choroid thickness at two time points (first visit vs last visit) with a minimum interval of 3y. RESULTS: In the GCC inner ring, a thinner thickness (P=0.001) was observed in the atrophic AMD group (51.3±21.4 µm) compared to the early AMD (84.3±11.5 µm), intermediate AMD (77.6±16.1 µm) and neovascular AMD (88.9±16.3 µm) groups. Choroidal thickness quantification showed a generalized reduction in the central circle (P=0.002) and inner ring (P=0.001). Slight reductions in retinal thickness were more accentuated in the inner ring in the atrophic AMD (-13%; P<0.01). CONCLUSION: The variation of the analyzed structures could be an indicator of risk of progression with neurodegenerative (GCC) or vascular (choroid) pattern in the intermediate and atrophic AMD. The quantification of both structures can provide important information about the risk of disease progression in the early and intermediate stages but also for the evolution pattern into late stages (atrophic or neovascular).
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Abdussalam M Abdullatif, Alimulhaq Mohammad Moamnlhaq, Tamer A. Macky, Noha Ahmed Edris
2025,18(1):111-116, DOI: 10.18240/ijo.2025.01.13
Abstract:
AIM: To compare the macular and optic nerve perfusion and vascular architecture using optical coherence tomography angiography (OCTA) in normal eyes of Egyptian (Caucasians) and South Asian (Asians) volunteers. METHODS: Cross-sectional analytical OCTA study performed on 90 eyes of South Asian (n=45) and Egyptians (n=45) were analyzed. All participants underwent best-corrected visual acuity test, slit lamp, and fundus examination. OCTA images; macular 6×6 mm2 grid and optic nerve 4.5×4.5 mm2 grid were used to examine the parafoveal and peripapillary regions, respectively. RESULTS: The mean capillary vessel density (CVD) in macular sectors among South Asians and Egyptians participants were (50.31%±2.53%, 51.2%±5.93%) and (49.71%±3.6%, 51.94%±4.79%) in superficial (SCP) and deep capillary plexuses (DCP), respectively (P>0.05). Mean CVD in both groups was higher in DCP compared to SCP in all sectors but was not significant (P>0.05). Mean foveal CVD increases with an increase in central retinal thickness in both SCP and DCP (P<0.001), among both groups. Mean area of the foveal avascular zone (FAZ) was 0.28±0.09 and 0.27±0.08 mm2 in South Asian and Egyptians, respectively. FAZ area decreases with an increase in the thickness and foveal CVD (P<0.001). Mean CVD in the peripapillary area was 48.23%±5.78% in South Asian and 49.52%±2.38% in Egyptian volunteers. The mean retinal nerve fiber layer thickness was found to be higher in the nasal quadrant among South Asian females than the Egyptian females (P<0.05). CONCLUSION: No significant racial disparity is found in this study. The findings are helpful for assessing and improving the normative data on the differences in South Asian and Egyptian populations.
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Yu-Hao Ye, Yi-Yong Xian, Fang Liu, Zhong-Lin Lyu, Xing-Tao Zhou, Jing Zhao
2025,18(1):117-124, DOI: 10.18240/ijo.2025.01.14
Abstract:
AIM: To investigate the effect of 0.01% low-concentration atropine (LA) on quantitative contrast sensitivity function (qCSF) in children with myopia. METHODS: This paired case-control study included 90 eyes of 58 children who were sex-, age-, and refraction-matched and equally divided into two groups: the 0.01% LA group had undergone 6mo use of daily 0.01% atropine and control group was naïve to LA. Routine ophthalmic examinations and qCSF test without refractive correction were performed. Two groups were compared in monocular and binocular qCSF parameters, including the area under logCSF, CSF acuity, and contrast sensitivity (CS) at 1.0-18.0 cycle per degree (cpd). RESULTS: In the monocular comparison, the CSF acuity of the LA group was significantly higher than that of the control group (7.58±5.51 vs 6.37±4.22 cpd, P<0.05). The subgroup analysis showed that in the 6-9y group, CSF acuity was significantly higher in the LA group than the control group (8.76±6.19 vs 6.54±4.25 cpd, P<0.05), and in the Female group, low refraction sphere group, and high refraction cylinder group, the CS at high spatial frequencies (12.0 and 18.0 cpd) were significantly higher in the LA group than in the control group (all P<0.05). In the binocular test, CSF acuity and CS at 12.0 cpd were significantly higher in the LA group than in the control group (10.95±7.00 vs 8.65±5.12 cpd; 0.17±0.33 vs 0.06±0.16, respectively; both P<0.05). CONCLUSION: Use of LA may result in improved CS in children with early onset myopia.
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Bing-Jie Chen, Yu-Chen Fan, Yong-Chuan Liao
2025,18(1):125-131, DOI: 10.18240/ijo.2025.01.15
Abstract:
AIM: To evaluate the effect of femtosecond laser small incision lenticule extraction (SMILE) on the binocular visual function in myopic patients with glasses-free three-dimensional (3D) technique. METHODS: Totally 50 myopic patients (39 females and 11 males) with SMILE were enrolled in this prospective study. The glasses-free 3D technique was used to evaluate the binocular visual function in these subjects including static stereopsis, dynamic stereopsis, foveal suppression, and binocular balance point of signal to noise ratio (s/n ratio). All subjects received measurements in 1d before operation, and 1d, 1wk, and 1mo postoperatively. RESULTS: Both static and dynamic stereopsis showed no significant difference after SMILE. The foveal suppression improved significantly 1wk and 1mo after SMILE (P=0.005 and P=0.007 respectively). The binocular balance point of signal to noise ratio showed a significant improvement 1d, 1wk and 1mo after SMILE for both eyes (P<0.001 for each eye respectively). CONCLUSION: Glasses-free 3D technique can be used to evaluate the effect of SMILE on the binocular visual function in myopic patients perceptively, and SMILE can improve both foveal suppression and binocular imbalance in these patients.
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Mary Ellaine S. Diaz, Ruben Lim Bon Siong, Justin Alan Yao, Gary John V. Mercado
2025,18(1):132-138, DOI: 10.18240/ijo.2025.01.16
Abstract:
AIM: To evaluate the demographics, clinical characteristics, treatments, and outcomes of patients with ocular surface squamous neoplasia (OSSN) at the Philippine General Hospital. METHODS: This was a single-center, 11-year retrospective, cross sectional case series on 18 cases of OSSN seen between January 2012 to June 2023. The patient’s demographics, presenting symptoms, tumor characteristics, histopathologic diagnosis, treatment, outcomes, and duration of follow-up were reviewed. RESULTS: Out of 33 identified cases of OSSN, only 18 were eligible for inclusion in the study. Mean age was 60.78y (range 31 to 80), with male predominance (66.67%). The left eye was most commonly affected (61.11%) with most presenting with fleshy mass (83.33%). Most tumors were located nasally (66.67%) and were predominantly papilliform (44.44%) in morphology with associated hyperpigmentation (38.89%). Squamous cell carcinoma (SCCA) was the most common histopathologic diagnosis (72.22%). The main primary treatment was surgical excision (94.44%) with or without adjunctive therapy, with only 1 patient undergoing first-line topical chemotherapy. Only 3 recurrences (16.67%) were noted with a median follow-up of 7.5mo. A statistically significant recurrence-free odds leaning towards the utilization of cryotherapy was noted. CONCLUSION: OSSN seen at the Philippine General Hospital is presented as a limbal papilliform mass, most commonly affecting elderly males. Surgical excision with adjuvant cryotherapy and/or chemotherapy is the preferred mode of treatment.
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2025,18(1):139-145, DOI: 10.18240/ijo.2025.01.17
Abstract:
AIM: To assess the relationship between dietary inflammatory index (DII) and prevalence of glaucoma among individuals aged 40y and above in the United States. METHODS: Participants were drawn from 2 cycles of the National Health and Nutrition Examination Survey (NHANES, 2005-2008) for a cross-sectional study. DII was calculated from 24-hour dietary recall questionnaire conducted by experienced researchers and data analyzed in R according to the NHANES user guide, “Stratified Multi-stage Probability Sampling”. The relationship between DII and glaucoma was evaluated by multi-factor logistic regression analysis and the existence of a non-linear association examined by restricted cubic spline (RCS) analysis. RESULTS: A total of 5359 subjects were included and the cross-sectional analysis weighted to represent the US population of 109 million. DII was elevated in glaucoma patients (P<0.001) and smoking and alcohol use contributed to significant differences (P<0.001). DII correlated negatively with Healthy Eating Index (HEI)-2015 (Spearman rank correlation coefficient, r=-0.49). RCS analysis showed a linear relationship between DII and glaucoma risk (P of non-linear relationship =0.575). CONCLUSION: An increased DII is strongly associated with high risk of glaucoma and diet-induced inflammation should be controlled to delay glaucoma progression.
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Yi-Man Li, Xin Zhang, Ji-Hong Zeng, Hong-Mei Luo
2025,18(1):146-153, DOI: 10.18240/ijo.2025.01.18
Abstract:
AIM: To evaluate the prevalence of early post-traumatic stress disorder (PTSD) among young and middle-aged patients who have suffered open globe injuries, and to identify the psychosocial factors influencing PTSD in these patients. METHODS: A total of 280 patients who underwent ocular trauma surgery between January 2023 and January 2024 were selected through convenience sampling. Data were collected using a custom-designed demographic questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), the Cognitive Emotion Regulation Questionnaire (C-ERRI), and the PTSD Checklist-Civilian Version (PCL-C). Univariate analysis and stepwise multiple linear regression analysis were performed to determine the factors affecting PTSD in these patients. RESULTS: The average PTSD score for the patients was 33.22±13.48. The scores for individual PTSD dimensions, ranked from highest to lowest, were recurrent traumatic experiences, heightened arousal, avoidance reactions, and social dysfunction. Positive PTSD symptoms were observed in 85 patients (30.36%). Univariate analysis indicated that gender, postoperative vision, marital status, psychological resilience, and rumination were significant factors affecting PTSD symptoms (χ²/t=6.53, 17.88, 8.83, 2.17, and 14.1, respectively; all P<0.05). Pearson correlation analysis showed a positive correlation between rumination and PTSD symptoms (r=0.73, P<0.01) and a negative correlation between psychological resilience and PTSD symptoms (r= -0.14, P<0.05). Stepwise multiple linear regression analysis identified postoperative vision (notably eye removal), rumination levels, and psychological resilience (optimism) as major factors influencing PTSD in these patients (R²=0.57, P<0.001). CONCLUSION: Young and middle-aged patients with open globe injuries have a high incidence of PTSD. Significant risk factors for early PTSD include primary enucleation, high levels of rumination, and low psychological resilience (optimism). Conversely, patients with good postoperative vision recovery, low rumination levels, and high levels of optimism are less likely to develop PTSD. Healthcare providers should pay special attention to patients who undergo primary enucleation, strive to reduce their rumination levels, and enhance their psychological resilience, thereby promoting a positive and optimistic attitude towards their condition and reducing the incidence of PTSD.
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Hassan Hashemi, Fereshteh Shokrollahzadeh, Hadi Ostadimoghaddam, Abbasali Yekta, Mehdi Khabazkhoob
2025,18(1):154-159, DOI: 10.18240/ijo.2025.01.19
Abstract:
Biomechanical study of the visual system by ocular response analyzer investigates the inter-structural biological relationships, mechanics, and function of the visual system. This review aimed to investigate the changes in corneal biomechanical parameters with age and sex. The articles published in PubMed between 2000 and 2021 were investigated and critiqued, and valid scientific evidence was collected, reviewed and concluded according to the inclusion and exclusion criteria. Most studies showed that corneal biomechanical changes occur infrequently in children up to the age of 20y, and with increasing age and wider age range, there was a significant decrease in corneal biomechanical indices, especially corneal hysteresis. In children and adults, most studies have shown that these biomechanical indicators, especially corneal resistance factor, were higher in females. Although hormonal changes may contribute to this finding, the role of axial length and other biometric indicators should not be ignored. The axial length, the intraocular pressure, and the corneal thickness are other factors associated with biomechanical parameters that should be taken into account in clinical diagnosis and management especially for patients undergoing refractive surgery as well as keratoconus patients.
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2025,18(1):160-167, DOI: 10.18240/ijo.2025.01.20
Abstract:
Glaucoma is a group of diseases characterized by progressive optic nerve degeneration, with the characteristic pathological change being death of retinal ganglion cells (RGCs), which ultimately causes visual field loss and irreversible blindness. Elevated intraocular pressure (IOP) remains the most important risk factor for glaucoma, but the exact mechanism responsible for the death of RGCs is currently unknown. Neurotrophic factor deficiency, impaired mitochondrial structure and function, disrupted axonal transport, disturbed Ca2+ homeostasis, and activation of apoptotic and autophagic pathways play important roles in RGC death in glaucoma. This review was conducted using Web of Science, PubMed, Project, and other databases to summarize the relevant mechanisms of death of RGCs in glaucoma, in addition to outlining protective treatments to improve the degradation of RGCs.
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2025,18(1):168-177, DOI: 10.18240/ijo.2025.01.21
Abstract:
Improvements in surgical techniques have led to 90% success in the surgical repair of rhegmatogenous retinal detachment (RRD). However, anatomical reattachment of the retina does not ensure complete recovery of visual function. The incidence of metamorphopsia remains the most common postoperative complaint, from 24% to 88.6%. Currently, the risk factors of metamorphopsia are categorized into macular involvement, retinal shift, outer retinal folds, subretinal fluid, secondary epiretinal membrane, outer retinal layer damage, and surgical approach. The associations of metamorphopsia with postoperative best-corrected visual acuity and postoperative vision-related quality of life were still controversial. The most popular methods for assessment of metamorphopsia remain the Amsler grid and M-Charts. Most treatments cannot progress beyond the management of negative visual sensations, through methods such as occlusion therapy and aniseikonia-correcting spectacles. The main treatment approach involves RRD prevention and the management of risk factors that can lead to postoperative metamorphopsia after RRD repair. Additional research concerning metamorphopsia treatment, further upgrades of auxiliary inspection methods, and more accurate microstructural assessments are needed to address this common complication.
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2025,18(1):184-186, DOI: 10.18240/ijo.2025.01.24
Abstract:
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Wen-Bo Liu, Yi Cai, Miao Zhou, Hashimoto Kinji, Ming-Wei Zhao, Xuan Shi
2025,18(1):187-189, DOI: 10.18240/ijo.2025.01.25
Abstract:
Volume 18,2025 Issue 1
Intelligent Ophthalmology
Basic Research
Clinical Research
Investigation
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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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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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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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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