International journal of ophthalmology最新文献

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).

Mrthods: A sodium iodate (NaIO₃) mouse model as well as IL-17A ^-/- mice were established. The effects of inflammatory cytokines in RPE cells and retinal microglia before and after NaIO₃ modeling in vivo and in vitro, were investigated using immunofluorescence, immunoprotein blotting, and quantitative real-time fluorescence polymerase chain reaction (qRT-PCR), respectively. Interventions using recombinant IL-17A protein (rIL-17A) or IL-17A neutralizing antibody (IL-17A NAb) were used to observe the subsequent differences in fundus, fundus photography and optical coherence tomography (OCT), cell viability, and expression of oxidative stress-related markers before and after modeling, and to screen for key signaling pathways.

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.

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.

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.

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.

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.

Aim: To establish an animal model of form deprivation amblyopia based on a simulated cataract intraocular lens (IOLs).

Methods: Poly(dimethyl siloxane)-SiO₂ thin films (PSF) with different degrees of opacity as IOL materials were prepared. The light transmission of the PSF-IOL was measured, and its in vitro biosafety was determined by cell counting kit (CCK)-8 assay using the HLEC-B3 cell line and ARPE-19 cell line. Subsequently, the in vivo safety was determined by implanting the PSF-IOL with 10% wt SiO₂ into the right eyes of New Zealand white rabbits (PSF-IOL group), and compared with two control groups: contralateral comparison group and normal control (NC) group (Contralateral comparison group: the fellow eye; NC group: a group of binocular normal rabbits without intervention). The flash visual-evoked potentials (F-VEPs) were measured to verify amblyopia.

Results: PSFs containing 0, 2%, and 10% wt SiO₂ were successfully constructed. The 0 SiO₂ PSF was transparent, while the 10% wt SiO₂ PSF was completely opaque. It was found that PSF did not induce unwanted cytotoxicity in HLECs and ARPE19 cells in vitro. In vitro, PSF-IOL with 10% wt SiO₂ was also non-toxic, and no significant inflammation or structural changes occurred after four weeks of PSF-IOL implantation. Finally, our IOL-simulated congenital cataract rabbit detected by F-VEPs suggested tentative amblyopia.

Conclusion: A PSF-IOL that mimics cataracts is created. A novel form deprivation model is created by the IOL-simulated congenital cataract rabbit. It can be developed fast and stable and holds great potential for future study.

Aim: To investigate the features of retinal ischemic injuries in a novel mouse model with bilateral carotid artery stenosis (BCAS).

Methods: BCAS was induced with microcoil implantation in 6-8-week-old C57BL6 mice. Cerebral blood flow was monitored at 2, 7, and 28d postoperatively. Retinal morphological changes were evaluated by fundus photography and hematoxylin-eosin staining. Fluorescein fundus angiography (FFA) was performed to detect retinal vascular changes and circulation. The levels of apoptosis, activation of neurogliosis, and expression of hypoxia-inducible factor (HIF)-1α in the retina were assessed by Western blotting and immunofluorescence staining, followed by retinal ganglion cell (RGC) density detection. Additionally, electrophysiological examinations including photopic negative response (PhNR) was also performed.

Results: The mice demonstrated an initial rapid decrease in cerebral blood flow, followed by a 4-week recovery period after BCAS. The ratio of retinal artery and vein was decreased under fundus photography and FFA. Compared with the sham mice, BCAS mice showed thinner retinal thickness on day 28. Additionally, apoptosis was increased and RGC density was decreased mainly in peripheral retinal region. Neurogliosis was mainly located in the inner retinal layers, with a stable increase in HIF-1α expression. The dark-adapted electroretinogram showed a notable reduction in the a-, b-, and oscillatory potential (OP) wave amplitudes between days 2 and 7; this gradually recovered over the following 4wk. However, the b- and OP-wave amplitudes were still significantly decreased on PhNR examination on day 28.

Conclusion: BCAS can result in relatively mild retinal ischemia injuries in mice, mainly in the inner layer and peripheral region. Our study provides a novel animal model for investigating retinal ischemic diseases.

Aim: To investigate the magnitude of problem caused by resistant corneal ulcers and its epidemiological characteristics.

Methods: Patients with corneal lesions were selected and carefully examined and cases with resistant corneal ulcers were further investigated and data were recorded using a specific data sheet designed in hospital. Then, collected data from patients were statistically analyzed.

Results: Totally 1939 cases were included in the study, including 816 fungal cases (42.1%) and 1123 (57.9%) non-fungal cases. Age of the participants ranged from 18 to 73y. Fungal cases were more common in middle age (35-55y). Men were more affected (53.5%) of cases included in the study. Keratomycosis affected more unskilled personnel (75.1%), large families with small houses (higher crowding index 73.9%), rural (64.5%) residence. Patients with sanitary water sources (34.8%) and waste disposal (24.4%) were less affected.

Conclusion: Keratomycosis is more frequent in unskilled personnel, rural locations, outdoor water sources and insanitary waste disposal systems. Corneal trauma and contact lens are common risk factors.

Aim: To explore the current application and research frontiers of global ophthalmic optical coherence tomography (OCT) imaging artificial intelligence (AI) research.

Methods: The citation data were downloaded from the Web of Science Core Collection database (WoSCC) to evaluate the articles in application of AI in ophthalmic OCT published from January 1, 2012 to December 31, 2023. This information was analyzed using CiteSpace 6.2.R2 Advanced software, and high-impact articles were analyzed.

Results: In general, 877 articles from 65 countries were studied and analyzed, of which 261 were published by the United States and 252 by China. The centrality of the United States is 0.33, the H index is 38, and the H index of two institutions in England reaches 20. Ophthalmology, computer science, and AI are the main disciplines involved. Hot keywords after 2018 include deep learning (DL), AI, macular degeneration, and automatic segmentation.

Conclusion: The annual number of articles on AI applications in ophthalmic OCT has grown rapidly. The United States holds a prominent position. Institutions like the University of California System and the University of London are spearheading advancements. Initial researches centered on the automatic recognition and diagnosis of ocular diseases leveraging traditional machine learning (ML) technology and OCT images. Nowadays, the imaging process algorithm selection has shifted its focus towards DL. Concurrently, optical coherence tomography angiography (OCTA) and computer-aided diagnosis (CAD) have emerged as key areas of contemporary research.

Aim: To describe the distribution of refractive errors by age and sex among schoolchildren in Soacha, Colombia.

Methods: This was an observational cross-sectional study conducted in five urban public schools in the municipality of Soacha. A total of 1161 school-aged and pre-adolescent children, aged 5-12y were examined during the school year 2021-2022. Examinations included visual acuity and static refraction. Spherical equivalent (SE) was analysed as follows: myopia SE≤-0.50 D and uncorrected visual acuity of 20/25 or worse; high myopia SE≤-6.00 D; hyperopia SE≥+1.00 D (≥7y) or SE≥+2.00 D (5-6y); significant hyperopia SE≥+3.00 D. Astigmatism was defined as a cylinder in at least one eye ≥1.00 D (≥7y) or ≥1.75 D (5-6y). If at least one eye was ametropic, children were classified according to the refractive error found.

Results: Of the 1139 schoolchildren included, 50.6% were male, 58.8% were aged between 5 and 9y, and 12.1% were already using optical correction. The most common refractive error was astigmatism (31.1%), followed by myopia (20.8%) and hyperopia (13.1%). There was no significant relationship between refractive error and sex. There was a significant increase in astigmatism (P<0.001) and myopia (P<0.0001) with age.

Conclusion: Astigmatism is the most common refractive error in children in an urban area of Colombia. Emmetropia decreased and myopia increased with age.