International journal of ophthalmology最新文献

Aim: To find out the association of secreted protein acidic and rich in cysteine (SPARC)-related modular calcium binding 2 (SMOC2) gene variants rs2255680 and rs13208776 with genotypic and phenotypic characteristics in both familial and non-familial primary open angle glaucoma (POAG) patients.

Methods: A total of 212 POAG patients, comprising 124 familial and 88 non-familial, were enrolled. For genotyping the SMOC2 variant rs2255680, amplification refractory mutation system (ARMS)-polymerase chain reaction (PCR) method and PCR-restriction fragment length polymorphism (PCR-RFLP) were utilized for analyzing rs13208776 variant.

Results: The mean age of familial POAG patients was 50.92±9.12y, with 78 males and 46 females. The mean age of non-familial POAG patients was 53.14±13.44y, with 52 males and 36 females. The SMOC2 gene variant rs13208776 showed the significant association with POAG between familial and non-familial groups. The homozygous G/G variant was frequent among non-familial (60.2%) whereas the heterozygous G/A variant was more frequent in familial POAG patients (46%). There were significant differences in G/A variant between familial and non-familial glaucoma patients, and the risk was decreased to 0.53-fold in non-familial glaucoma patients [odds ratio (OR): 0.53; 95% confidence interval (CI): 0.29-0.94; P=0.033] in codominant model. The risk was further reduced to 0.49-fold (95%CI: 0.28-0.86; P=0.012) in dominant model for non-familial patients. No significant association of SMOC2 gene variant rs2255680 between familial and non-familial glaucoma patients was found in our population. The haplotype analysis showed the decreased risk for TA [OR: 0.48 (95%CI: 0.29-0.79); P=0.004] and an increased risk for TG [OR=2.28 (95%CI: 1.22-4.25); P=0.01] haplotypes.

Conclusion: Current findings show significant association of SMOC2 gene variant rs13208776 with POAG between familial and non-familial Pakistani patients.

Aim: To investigate the efficacy of systemic mycophenolate mofetil (MMF) as an adjunct in combination with topical tacrolimus (FK506) and corticosteroid eyedrops for preventing corneal graft rejection after high-risk keratoplasty (HRK).

Methods: In this cohort study, 55 consecutive patients (55 eyes) from an eye center who met the criteria of HRK were included. The definition for HRK includes large grafts of no less than 9 mm diameter, vascularized cornea of two or more quadrants, regrafting, or eccentric grafts. After penetrating keratoplasty, 25 patients treated with systemic MMF in combination with 0.05% FK506 and tapering corticosteroid eyedrops were enrolled in Group 1 from October 2019. Thirty patients receiving postoperative treatment with 0.05% FK506 and tapering corticosteroid eyedrops alone were enrolled in Group 2 from January 2018 to September 2019. All participants were closely monitored after surgery, and episodes of graft rejection and relevant clinical data were collected and assessed over a one-year follow-up period.

Results: After a follow-up of 9.6±3.2mo, graft rejection episodes occurred in 4 cases (16%) in Group 1 and 18 cases (60%) in Group 2. One reversible and 3 irreversible graft rejections occurred in Group 1, while 3 reversible and 15 irreversible rejections occurred in Group 2. Kaplan-Meier analysis revealed that 82.5% of grafts in Group 1 and 37.1% in Group 2 did not experience corneal graft rejection (P<0.01, log-rank test). The clear graft survival rate was 83.6% in Group 1 and 36.7% in Group 2 (P<0.01, log-rank test) within one year of follow-up. No severe systemic side effects were observed in either group during the follow-up period.

Conclusion: The triple treatment regimen consisting of MMF, topical FK506, and corticosteroid eyedrops represents a promising strategy for effectively preventing graft rejection and improving graft survival in patients with HRK.

Aim: To establish a stable, short-time, low-cost and reliable murine model of meibomian gland dysfunction (MGD).

Methods: A filter paper sheet soaked in 1.0 mol/L sodium hydroxide (NaOH) solution was used to touch the eyelid margin of C57BL/6J mice for 10s to establish the model. The other eye was left untreated as a control group. Eyelid margin morphological changes and the meibomian glands (MGs) were observed by slit lamp microscopy on days 5 and 10 post-burn. Hematoxylin-eosin (HE) staining and Oil red O staining were adopted in detecting the changes in MGs morphology and lipid deposition. Real-time polymerase chain reaction, Western blot, immunofluorescence staining and immunohistochemical staining were used to detect interleukin (IL)-6, IL-1β, IL-18, tumor necroses factor (TNF)-α, interferon (IFN)-γ, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 4 (NOX4), 3-nitroturosine (3-NT), 4-hydroxynonenal (4-HNE) and cytokeratin 10 (K10) expression changes in MGs.

Results: MGs showed plugging of orifice, glandular deficiency, abnormal acinar morphology, ductal dilatation, and lipid deposition after alkali burn. The expressions of IL-6, IL-18, IL-1β, IFN-γ, and TNF-α indicators of inflammation and oxidative stress in MGs tissues were significantly increased. Abnormal keratinization increased in the MG duct.

Conclusion: A murine model of MGD is established by alkali burn of the eyelid margin that matches the clinical presentation of MGD providing a stable, short-time, low-cost, and reliable MGD model. The new method suggests efficient avenues for future research.

Aim: To assess the corneal high-order aberration (HOA) and its correlation with corneal morphological parameters in patients with bilateral keratoconus (KCN) and unilateral Vogt's striae.

Methods: A total of 168 eyes of 84 patients with KCN, whose corneas had definite signs of unilateral Vogt's striae, were enrolled. Corneal HOA and morphological parameters were measured using Pentacam HR.

Results: The corneal morphological parameters between KCN eyes with and without Vogt's striae were evidently different (P<0.001). The 3^rd coma 90°, 4^th spherical aberration, 5^th coma 90°, root-mean-square (RMS) (total), and RMS (HOA) in the front, back surfaces and total cornea in KCN eyes with Vogt's striae were significantly higher than those in KCN eyes without Vogt's striae (P<0.001). In KCN eyes with Vogt's striae, the 3^rd coma 90° and 4^th spherical aberration in the front surface and total cornea were negatively correlated with flat keratometry value (K1), steep keratometry value (K2), mean keratometry value (Km), maximum keratometry value (Kmax), anterior corneal elevation (ACE), and posterior corneal elevation (PCE; P<0.05). The 3^rd coma 90°, 4^th spherical aberration in back surface and RMS (total), RMS (HOA) in the front, back surfaces, total cornea were positively correlated with K1, K2, Km, Kmax, ACE, and PCE (P<0.05).

Conclusion: Corneal HOA especially vertical coma and spherical aberration may increase when Vogt's striae appeared in KCN eyes. The scale of increase is significantly related with changes in corneal shapes.

Aim: To observe the clinical outcomes of 30-gauge (G) needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management.

Methods: Eight patients with atonic pupils who underwent suture purse-string pupilloplasty were retrospectively analyzed. Preoperative data and at least 6mo of postoperative data were collected from all the patients.

Results: The corrected distance visual acuity (CDVA) before and after surgery was 0.58±0.22 and 0.20±0.10 logMAR, respectively (P=0.002). The pre- and postoperative pupil size was 7.38±0.88 and 3.09±0.71 mm (P=0.000), respectively. The corneal endothelial cell count was 2841±176/mm² before and 2692±143/mm² after surgery (P=0.000). No intraoperative or postoperative complications were reported. During the follow-up period of at least 6mo, all treated pupils were centered and generally or nearly round. Furthermore, the patients did not exhibit photophobia, glare, or diplopia.

Conclusion: This technique is a simple and effective method for pupil reduction.

Aim: To assess the utility and efficiency of endoscopy-assisted vitrectomy (EAV) for the treatment of corneal opacity in severe ocular trauma.

Methods: Patients who underwent fundus examination using a preoperative slit lamp and intraoperative endoscopy, followed by EAV and additional surgery were retrospectively recruited. Silicone oil removal and penetrating keratoplasty were used in selected eyes at postoperative follow-ups. Outcome measurements included the best corrected visual acuity (BCVA), intraocular pressure (IOP), findings of endoscopic fundus examination, and postoperative complications.

Results: Twenty-one eyes with severe ocular trauma and corneal opacity were followed up for 24-36mo. Retinal detachment (RD) and vitreous haemorrhage (VH) were identified in 16 eyes (76.2%), RD only in four eyes (19.0%), and VH combined with intraocular foreign body in one eye (4.8%). All eyes underwent at least three surgeries. Stage-I surgeries involved wound closure (100%), lens extraction (76.2%), and anterior vitrectomy (14.3%). Stage-II surgeries involved scleral buckling (28.6%), membrane peeling (47.6%), retinal laser photocoagulation (100%) and silicone oil tamponade (100%) using EAV. Stage-III surgeries were conducted using endoscopy including silicone oil removal (52.4%), retinal laser photocoagulation (52.4%) and penetrating keratoplasty (28.6%). Nearly all eyes showed improvements in BCVA and IOP. Although there were no severe complications, glaucoma was noted in one eye, chronic hypotony in another eye, and band keratopathy in three eyes.

Conclusion: EAV is an effective adjunct for restoring ocular anatomical structures and visual function in the case of corneal opacity after severe ocular trauma.

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

Aim: To evaluate the clinical efficacy and feasibility of superficial corneal opacities treated by excimer laser phototherapeutic keratectomy (PTK) combined with small incision lenticule extraction (SMILE)-derived corneal stromal lenticule transplantation.

Methods: A retrospective interventional case series of nine patients aged 12-59y with superficial corneal opacity caused by different pathologies who underwent standardized PTK combined with SMILE-derived corneal stromal lenticule transplantation was examined. Lenticule patches were fixed with fibrin glue. All patients underwent pre- and post-operative clinical assessments at different times for up to 12mo. Slit lamp microscopy, corneal density, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and anterior segment optical coherence tomography (AS-OCT) were examined.

Results: The patients' mean age was 36.00±5.80 (12-59)y. Seven eyes (77.8%) gained UDVA and CDVA at the last measurement compared to their preoperative levels. The densities of the total cornea, the total anterior corneal layer, and the anterior corneal layers of 0-2 and 2-6 mm decreased significantly by 12.4%, 27.5%, 46.7%, and 32.8%, respectively. After human allogeneic transplantation, the implanted lenticules of all eyes were clearly visible by AS-OCT and remained transparent without displacement or graft rejection. The thickness of the central cornea and corneal lenticule transplants were stable throughout the entire postoperative period. One case experienced the postoperative complication of delayed corneal epithelial healing.

Conclusion: PTK combined with SMILE-derived corneal lenticule transplantation improves long-term visual acuity. Therefore, it is a new, safe, and effective method for treating superficial corneal opacity.