Eye and Vision最新文献

Background: Diabetic keratopathy (DK) is a common ocular complication of diabetes, with its progression closely linked to autophagy regulation. This study aims to explore the role of long non-coding RNAs (lncRNAs) in modulating autophagy during diabetic pathogenesis, focusing on lncRNA general transcription factor IIIC subunit 1 (GTF3C1) and its potential as a therapeutic target for diabetic corneal neuropathy (DCN).

Methods: High-throughput sequencing identified dysregulated lncRNAs in the trigeminal ganglia of diabetic mice. Functional validation included mechanistic studies on lncRNA GTF3C1, miR-542-3p, and autophagy-related targets. Autophagy activity, corneal nerve density, and epithelial healing were quantified using quantitative real-time polymerase chain reaction (qRT-PCR), immunofluorescence, and histology in diabetic models.

Results: lncRNA GTF3C1 was significantly downregulated in diabetic trigeminal ganglion (TG). It functioned as a molecular sponge for miR-542-3p, alleviating its repression on GABA type A receptor-associated protein (GABARAP) and phosphatase and tensin homolog (PTEN), thereby enhancing autophagy activity. This process promoted corneal nerve fiber regeneration and epithelial wound healing in diabetic mice.

Conclusions: Our findings highlight lncRNA GTF3C1 as a critical regulator of autophagy in diabetic corneal nerves, offering a potential diagnostic and therapeutic target for DCN. This study provides molecular insights into the pathogenesis of DCN and lays the groundwork for future clinical strategies.

Background: This retrospective study aimed to identify risk factors for subretinal fibrosis (SF) and evaluate the response to anti-vascular endothelial growth factor (anti-VEGF) therapy in patients with myopic choroidal neovascularization (mCNV), with a specific focus on the role of dilated choroidal vessels (DCVs) in disease progression.

Methods: In this retrospective study, patients with high myopia (spherical equivalent < -6.0 D, pathological myopia, Asian ethnicity) and active mCNV lesions, diagnosed between 2021 to 2023, were evaluated. The location of DCVs and mCNV was assessed, and macular thickness, submacular choroid thickness, best-corrected visual acuity, CNV area, and flow density were measured at baseline and during follow-up. The presence of posterior staphyloma was evaluated at baseline. SF around the mCNV was evaluated lesions during follow-up. The time to SF detection was recorded using survival analysis. Risk factors for SF were analyzed using Kaplan-Meier and multivariable Cox regression analyses.

Results: A total of 46 eyes from 46 patients were included, with a mean age of 54.17 ± 14.37 years, and a baseline spherical equivalent of 12.36 ± 3.21 D. The logarithm of the minimum angle of resolution for the mean visual acuity was 0.70 (0.40-1.30), and the mean macular thickness was 313.11 ± 63.57 μm at baseline. DCV was detected in 29 of the 46 eyes (63.0%), and the median time to detect SF was 43.41 [95% confidence interval (CI): 37.27-49.55] months. Multivariable Cox regression analysis identified submacular DCV [hazard ratio (HR): 14.93, 95% CI: 5.72-38.91, P < 0.001) and absence of posterior staphyloma (HR: 43.48, 95% CI: 12.15-156.32, P = 0.002) as independent predictors of SF. The presence of DCV under the fovea compared to the peripheral zone achieved a poorer therapeutic response and was prone to progress to SF after anti-VEGF therapy (P = 0.041).

Conclusions: Submacular DCV is associated with poor therapeutic response to anti-VEGF therapy and an increased risk of SF in patients with mCNV.

Purpose: To assess the ability of corneal epithelial aberrations to discriminate forme fruste keratoconus (FFKC) and keratoconus (KC) from normal eyes.

Methods: This prospective, case-control study enrolled 91 right eyes from 91 normal participants, 87 eyes with FFKC and 148 eyes with KC. Epithelial aberrations for the 6-mm pupil were measured using an anterior segment optical coherence tomography (MS-39, CSO). The epithelial root mean square of higher and lower-order aberrations (total RMS), root mean square of higher-order aberrations (HOAs RMS, from the 3rd to the 7th Zernike polynomials), coma, trefoil, spherical aberration, and secondary astigmatism were recorded. Stepwise logistic regression was utilized to develop the epithelial aberrations index (EAI) for obtaining the optimal discriminant function to diagnose FFKC (EAI-FFKC) and KC (EAI-KC). Area under the receiver operating characteristic curve (AUC) analysis was used to determine the diagnostic accuracy of the indices.

Results: FFKC and KC eyes had significantly higher epithelial aberrations than normal eyes. Comparing FFKC with the normal group, epithelial HOAs RMS and coma attained AUC values of 0.714 and 0.788, respectively. The EAI-FFKC showed the highest discrimination ability to differentiate FFKC from normal eyes indicated by an AUC value of 0.822 with 77.0% sensitivity and 75.8% specificity. Comparing KC with the normal group, epithelial HOAs RMS attained AUC values of 0.976-0.998 with 95.2%-100% sensitivity and 92.3%-96.7% specificity, epithelial coma attained AUC values of 0.974-0.997 with 92.9%-100% sensitivity and 96.7%-98.9% specificity. The EAI-KC showed the highest discriminative ability to differentiate KC from normal eyes indicated by AUC of 0.996 with 98.6% sensitivity and 98.9% specificity.

Conclusion: Epithelial wavefront analysis can identify abnormal epithelial changes across all stages of KC, from very early to severe. Epithelial aberrations can be used as a diagnostic tool for KC and FFKC.

Macular hole surgery, primarily pars plana vitrectomy with internal limiting membrane peeling (ILM) and gas tamponade, has become the standard of care for full-thickness macular hole (FTMH). Despite the 85% to 95% anatomical closure rate, several aspects of the procedure are well accepted whereas some may remain controversial among vitreoretinal surgeons. An international panel of experts (IPE) comprising 27 experts from 10 countries/territories was established to evaluate a total of 38 consensus statements on ILM peeling extent, vital dye selection, face-down positioning requirements, tamponade options, timing of surgery and re-surgery, management of difficult and refractory cases, and adjuvant therapies. The objective is to synthesize evidence-based real-world practice recommendations from leading global experts to guide the management of FTMH. Of the 38 statements, the IPE reached consensus (75% voted as "Strong Agreement" or "Agreement") on 29 (76.3%). The IPE emphasized the importance of individualized patient factors-such as hole size, chronicity, lens status, and preoperative visual acuity-in surgical planning and tempering patient's postoperative expectations. There was strong agreement on the need of adequate peeling of the ILM, adjunctive measures including the inverted ILM flap, and face-down positioning for large and refractory FTMH. Controversial statements, such as the use of air tamponade or observation of small FTMH, not reaching consensus are identified. We hope the consensus statements agreed and disagreed by the IPE would help serve as good reference and guidelines in managing FTMH.

Bone morphogenetic proteins (BMPs), belonging to the transforming growth factor β (TGF-β) family, are multifunctional growth factors predominantly distributed in human bone tissue. Some studies also have revealed that BMPs are widely expressed in ocular tissues. Over the past two decades, research on the therapeutic application of BMPs has yielded significant advancements not only in the treatment of skeletal, cardiac, renal and neurological diseases but also in ocular conditions. Both in vivo and in vitro experiments have demonstrated the significant therapeutic efficacy of BMPs in various ocular disorders, including myopia, corneal opacity, cataract, uveal melanoma, retinal detachment and other eye diseases. Studies have further identified that BMPs exert their actions through mechanisms closely associated with the canonical Smad pathway. Compared to traditional therapeutic drugs, BMPs exhibit some advantages, including low toxicity, minimal side effects, amongst others. However, numerous unresolved issues persist during in vivo and in vitro experiments. The objective of this review is to explore the advancements in the application of BMPs for the treatment of ocular diseases in animal models or in vitro experiments, and to provide some insights into the challenges that need to be addressed for the translation of BMP-based therapies into clinical practice.

Background: Anti-angiogenic therapy with anti-vascular endothelial growth factor (anti-VEGF) is currently the first-line treatment for macular edema (ME), but the specific metabolic changes in the aqueous humor (AH) after intravitreal anti-VEGF injections remain poorly understood.

Methods: A total of 120 AH samples from 60 ME patients before and after anti-VEGF treatment were collected from the ophthalmology clinic and ward of the Eye Hospital of Wenzhou Medical University. Non-targeted metabolomics analysis of the AH samples was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Orthogonal partial least squares discriminant analysis (OPLS-DA) was used to identify metabolite differences before and after anti-VEGF treatment in patients with different ME etiologies.

Results: Distinct metabolomic profiles were observed between pre- and post-treatment samples. A total of 145 significantly altered metabolites were identified after anti-VEGF treatment, with 84 upregulated metabolites related to carbohydrate and amino acid metabolism, and 61 downregulated metabolites involved in amino acid metabolism. Both common and etiology-specific metabolic alterations were observed. In age-related macular degeneration (AMD)-ME, treatment-induced metabolic changes mainly involved amino acid metabolism, whereas in branch retinal vein occlusion (BRVO)-ME, lipid metabolism was primarily affected. Diabetic macular edema (DME) patients showed more complex metabolic alterations, involving amino acid, lipid and carbohydrate metabolism.

Conclusions: Intravitreal anti-VEGF injections significantly alter AH metabolites in ME patients. These findings provide insight into underlying metabolic processes in ME pathogenesis and treatment efficacy.

Background: To analyze the fluid reservoir thickness over the whole cornea during scleral lens settling using wide-angle optical coherence tomography (OCT) images and customized computer software.

Methods: A total of 75 participants were recruited - 29 (myopes) with regular corneas and 46 with irregular corneas (35 with keratoconus, and 11 post-keratoplasty). All participants were fitted with customized scleral lenses and anterior segment OCT (Tomey Casia 2) images were taken 0, 30, 60, 120, and 240 min after lens application at the dispensing visit. Customized software was used to automatically segment the anterior cornea and the posterior surface of the scleral lens and determine the fluid reservoir thickness at 17 corneal regions across a 12 mm diameter.

Results: Fluid reservoir thickness decreased over time (P < 0.001) following an exponential decay, with no differences observed over time between the three groups (P = 0.97). The reduction in fluid reservoir thickness over four hours varied slightly between the central (149 ± 9 μm), mid-peripheral (139 ± 11 μm), and peripheral regions (131 ± 15 μm), P = 0.046. The fluid reservoir was thinnest in the superior mid-periphery for both the myopia and post-keratoplasty groups, and centrally for the keratoconus group. The fluid reservoir was thickest inferiorly for all groups, with the greatest level of asymmetry observed along the vertical meridian.

Conclusions: Fluid reservoir thickness decreased most rapidly during the first two hours of lens wear and followed an exponential decay for both regular and irregular corneas across all corneal locations. Fluid reservoir asymmetry was greatest along the vertical meridian with a thicker reservoir observed in the inferior corneal regions.

Background: Glaucoma causes permanent blindness. Current treatments have limited effectiveness, necessitating novel therapeutic strategies. We aimed to identify potential drug targets for glaucoma by integrating multi-trait and multi-omic analyses.

Methods: We sourced druggable gene expression and protein abundance summary-level data from quantitative trait loci studies, and genetic associations with glaucoma from a large-scale multi-trait analysis. We employed proteome and transcriptome Mendelian randomization (MR) and colocalisation to identify potential therapeutic targets, glaucoma endophenotype MR to explore the potential mechanisms of identified associations, and phenome-wide MR to investigate possible adverse effects of candidate targets.

Results: We identified CPXM1 and FLT4 as tier 1; INSR as tier 2; and CPZ and PXDN as tier 3 druggable genes. Genetically predicted higher levels of CPXM1 [odds ratio (OR): 0.86, 95% confidence interval (CI): 0.81-0.91, P_FDR < 0.001], FLT4 (OR: 0.74, 95% CI: 0.64 - 0.87, P_FDR = 0.033), INSR (OR: 0.58, 95% CI: 0.43 - 0.78, P_FDR = 0.042), and CPZ (OR: 0.55, 95% CI: 0.40 - 0.74, P_FDR = 0.033) were associated with decreased glaucoma risk while those of PXDN (OR: 1.33, 95% CI: 1.15 - 1.54, P_FDR = 0.033) with increased risk. The associations for CPXM1 (OR: 0.53, 95% CI: 0.39 - 0.73, P < 0.001) and FLT4 (OR: 0.86, 95% CI: 0.78 - 0.95, P = 0.005) were confirmed transcriptome-wide and colocalisation was confirmed for CPXM1 [posterior probability H4 (PPH₄) = 0.940], FLT4 (PPH₄ = 0.701), and INSR (PPH₄ = 0.706). The protective effects of CPXM1 and CPZ may be attributed to intraocular pressure-lowering activities. The risk associated with PXDN is due to its involvement in glaucomatous neuropathy. No significant adverse effects were identified.

Conclusions: This study provides novel insights into glaucoma pathophysiology and promotes pharmaceutical target innovation.

Background: Despite extensive research on keratoconus (KC) detection with traditional machine learning models, stacking ensemble learning approaches remain underexplored. This paper presents a stacking ensemble learning method to enhance automated KC screening.

Methods: This study utilizes a clinical dataset containing detailed corneal data from 2491 cases classified as non-KC (NKC), subclinical KC (SCKC) and clinical KC (CKC). Each cornea is represented by 79 features extracted from Pentacam imaging. Following extensive pre-processing, key corneal features that are strongly correlated with the target diagnosis are identified. These features are the keratometry of the steepest anterior point, surface variance index, vertical asymmetry index, height decentration index, and height asymmetry index. A novel stacking ensemble model is developed using the selected features to improve corneal classification into NKC, SCKC, and CKC by integrating top tree-based classifiers (random forest, gradient boosting, decision trees) with a support vector machine meta-classifier.

Results: The pre-processing and feature selection techniques reduced the model's parameters to just 6.33% of the original dataset, improving classification performance, and cutting over 85% of the training time. The performance of the developed model was validated and tested on unseen data. Experimental results showed that the model outperforms existing studies, achieving 99.72% accuracy, precision, sensitivity, F1, and F2 scores, with a Matthews correlation coefficient of 0.995. It accurately classified all NKC and CKC cases, with just one misclassification involving an SCKC case. The model also demonstrated consistent performance on 100 additional unseen test cases, underscoring its generalizability and robustness in KC screening.

Conclusions: By combining the strengths of diverse base models and key Pentacam indices, the stacking ensemble approach ensures reliable, accurate KC screening, providing clinicians with an automated tool for early detection and better patient management.

Background: A post hoc analysis of the STAR study, which was a 48-week, phase IV, multicenter randomized controlled multicenter clinical trial was performed. This study aims to identify the baseline factors associated with visual and anatomic changes over 48 weeks in the treatment of active polypoidal choroidal vasculopathy (PCV) with conbercept.

Methods: In the STAR study, 249 participants were randomized to either the 3 + Q12W (3 monthly injections followed by injections every 12 weeks) or 3 + TAE (3 monthly injections followed by treat and extend regimen) group. The association of 27 baseline factors with three outcomes-changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and maximum retinal thickness (MRT) from baseline to 48 weeks-was investigated using univariate regression analysis followed by multivariate linear regression analysis.

Results: The final multivariate model indicated that worse baseline BCVA (P < 0.01), CRT ≤ 400 μm (P < 0.01), fewer polypoidal lesions (P < 0.01), and younger age at baseline (P = 0.04) were associated with greater BCVA gain at week 48. Higher CRT and MRT at baseline were associated with a greater reduction in CRT and MRT at week 48, separately (P < 0.01 and P < 0.01, respectively). Smaller pigment epithelial detachment (PED) volume at baseline was associated with greater reductions in CRT and MRT at week 48 (both P < 0.01). Eyes with relatively good BCVA (> 73 letters) at baseline exhibited lower reductions in CRT and MRT at week 48 (P < 0.01 and P = 0.02, respectively). At week 48, eyes with hemorrhagic PEDs showed greater reductions in CRT and MRT than those with fibrovascular PEDs (P = 0.02 and P = 0.03, respectively). Furthermore, eyes with shallow irregular or sharp-peaked PEDs exhibited greater reductions in CRT (both P < 0.01) and MRT (P = 0.01 and P < 0.01, respectively) than those with multilobular PEDs from baseline to week 48.

Conclusions: In Chinese patients with PCV receiving intravitreal injections of conbercept, baseline characteristics, including age, BCVA, CRT, MRT, number of polypoidal lesions, PED volume, and PED types and morphology, served as predictors of visual and anatomical changes over 48 weeks.