International journal of ophthalmology最新文献

Aim: To employ proteome-wide Mendelian randomization (MR) to explore novel protein and drug targets for retinal neurodegenerative diseases (RND) in individuals of European ancestry.

Methods: This study used summary data-based MR to analyze the correlation between plasma protein levels and three RND, with protein data derived from two independent large-scale proteomics datasets. Potential drug targets were identified using Bayesian colocalization, followed by MR analysis, sensitivity testing, and external validation. Drug prediction and molecular docking were conducted to evaluate the druggability of the target proteins.

Results: The study identified six promising protein targets, each successfully replicated at least twice. The results included three proteins related to diabetic retinopathy (ICAM1, GCKR, WARS), two proteins related to age-related macular degeneration (WARS, BRD2), and two proteins related to glaucoma (SVEP1, NPTXR). Additionally, drug prediction and molecular docking indicated that five drugs (fenofibrate, trofinetide, ticagrelor, lifitegrast, acetaminophen) effectively bound to the target proteins.

Conclusion: This study identified six potential protein targets for RND and five existing drugs with therapeutic potential. By integrating plasma proteomics with genetic data, it provides a cost-effective framework for drug discovery.

Aim: To evaluate the influence of ocular biometric parameters on the performance of actual near-add power in the spectacle plane of multifocal intraocular lenses (MIOLs).

Methods: This retrospective study defined prediction error (PE) as the difference between actual postoperative near-add power and manufacturer-predicted values. Linear regression assessed PE correlations with axial length (AL), mean keratometry (K), pupil size, anterior chamber depth (ACD), lens thickness (LT), ACD+0.5×LT, and back-calculated IOL power. Differences in PE across MIOLs types, AL, K, pupil size, ACD, LT, ACD+0.5×LT, and back-calculated IOL power groups were compared.

Results: Totally 250 eyes of 250 patients (116 males and 134 females, mean age 56.22±12.31y) who underwent phacoemulsification with MIOL implantation were reviewed. PE showed no significant correlation with most parameters but had a weak positive correlation with LT. The mean predicted error (MPE) in the AL≤22, 26-27, and 27-28 mm groups were 0.83 (0.51, 1.01) D, 0.78 (0.51, 1.07) D, and 0.72 (0.57, 0.94) D respectively (P<0.001). The MPE in the K between the 45-46 D groups was 0.78 (0.37, 1.07) D (P=0.0004). The MPE in the LT between the 4.5-5.0 mm groups and ≥5 mm was 0.72 (0.50, 1.01) D and 0.72 (0.51, 1.01) D respectively (P<0.001). The MPE in the back-calculated IOL power ≥25 D was 0.86 (0.60, 1.01) D (P<0.001).

Conclusion: Although there is no significant linear relationship between near-add power and most ocular biometry parameters, and specific segments of AL, K, LT, and IOL power have a significant impact on the near-add power of MIOLs. These factors should be taken into account in preoperative evaluations.

Aim: To explore the mechanical indices used for differential diagnosis and to investigate the relationship between ocular biomechanics and glaucoma severity within each group.

Methods: This cross-sectional study included 185 eyes from 185 subjects: 62 normal controls, 91 high-tension glaucoma (HTG), and 32 normal-tension glaucoma (NTG) patients. All participants underwent a comprehensive ophthalmic examination that involved ocular biomechanical measurements. Glaucoma severity was assessed using visual field index (VFI), mean deviation (MD), pattern standard deviation (PSD) and retinal nerve fiber layer (RNFL) thickness. Multivariable models were used to compare fifteen biomechanical parameters among the three groups adjusting for age, gender, intraocular pressure (IOP), central corneal thickness (CCT), and axial length (AL). The generalized linear model was utilized for multifactor comparison.

Results: Significant differences in first applanation time (AT1), highest concavity time (HC time), stress strain index (SSI), and HC deflection were found among the three groups (P<0.05). AT1 was significantly higher in the HTG group compared to controls (P<0.05), and SSI was higher in HTG than NTG (P<0.05). HC deflection in the HTG group was significantly smaller than in NTG (P<0.05). Furthermore, AT1 levels were observed to be significantly higher in primary open angle glaucoma (POAG) patients compared to controls (P<0.05). Receiver operating charactristic (ROC) analysis showed HC deflection had an area under the curve (AUC) of 0.802 between HTG and NTG. A negatively significant correlation was observed between SSI and VFI in POAG patients.

Conclusion: Biomechanical analysis reveals that corneas in POAG patients are stiffer than normal controls, with increased corneal stiffness correlating with more severe glaucomatous damage. Interestingly, stiffer corneas in NTG patients appeares protective. In addition, HC deflection may be useful for differentiating HTG and NTG.

Aim: To evaluate parameters measured using the tear film imager (TFI) prototype, a new technology that enables to quantify the tear film thickness of lipid and mucoaqueous layers.

Methods: In this cross-sectional study, patients with dry eye, meibomian gland dysfunction (MGD), and non-dry eye/MGD from February 2020 to January 2021 were analyzed. Quantified TFI outputs included lipid layer thickness (LLT), mucoaqueous layer thickness (MALT), MALT rate of change (MALTR), and lipid breakup time. Two other interferometry devices, LipiView2 and DR-1α, were used for comparison. TFI outputs and other clinical parameters were analyzed using correlation coefficients. Each patient underwent one or several study visits. Baseline values of three device outputs, other clinical parameters, and their changes were examined.

Results: This study involved 28 patients (8 patients with dry eyes, 13 with MGD, and 7 with non-dry eye/MGD). Baseline TFI, LipiView2, and DR-1α values were associated with various clinical parameters. The LLT values estimated using TFI had a correlation with the plugging score in the upper eyelid (r=-0.42). Several TFI values have correlated better than LipiView2 and DR-1α, particularly with questionnaire scores. MALTR by TFI revealed a correlation between standardized patient evaluation on eye dryness (SPEED) and dry eye-related quality of life score (DEQS) scores (r=0.59, 0.43), respectively.

Conclusion: TFI enabled to quantify the LLT and MALT separately over time and shows the moderate correlations between TFI measurements and clinical parameters, which yields the potential for TFI to serve as a complementary tool for assessing dry eye and MGD.

Aim: To investigate the changes in posterior corneal elevation within 6mo after small incision lenticule extraction (SMILE) surgery for myopia and myopic astigmatism in patients with thin corneas.

Methods: A prospective study included patients with thin corneas (preoperative thinnest corneal thickness ranging from 480 to 520 µm) who underwent SMILE for myopia or myopic astigmatism. Corneal topography and posterior corneal elevation were assessed using Pentacam HR at three time points: preoperatively, 1mo, and 6mo postoperatively. The measured parameters included thinnest point elevation (PTE), posterior maximal elevation (PME), posterior central elevation (PCE), and 24 additional reference points.

Results: A total of 106 eyes from 106 patients (age range: 18-34) were included in the study. Uncorrected distance visual acuity (UDVA) improved significantly, with a mean logMAR value of -0.07±0.06 at the final follow-up visit. Measurements of posterior corneal elevation showed no significant changes in most points, hemispheres, and meridians at 6mo postoperatively. Notably, only two points, ∆E_2mm-45° and ∆E_2mm-90°, exhibited statistically significant elevation changes: the elevation of ∆E_2mm-45° increased from -2.3±4.99 to -1.0±5.9 µm (P=0.0037), and that of ∆E_2mm-90° increased from -16±7.53 to -15±7.4 µm (P=0.016). However, these changes were within the measurement error range of the Pentacam HR (±5 µm in a 5 mm area).

Conclusion: SMILE surgery is a safe and stable procedure for correcting myopia or myopic astigmatism in patients with thin corneas, as evidenced by the stability of posterior corneal elevation.

Aim: To investigate the effects of a Chinese medicine formula "Qingxuan Runmu Yin" (QRY) on ocular surface inflammation in a rat model of dry eye, and its mechanism via the toll-like receptor 4 (TLR4)/transforming growth factor kinase 1 (TAK1)/p38 mitogen-activated protein kinase (p38MAPK) signaling pathway.

Methods: Seventy-two Sprague-Dawley rats were randomly divided into six groups (n=12 each): the control group, model group, 3 groups of QRY (with low-, medium-, and high-doses), and SB203580 group. Dry eye was induced using benzalkonium chloride. Schirmer's test (SIT) and corneal fluorescein staining (CFS) were performed every 14d throughout the experiment. Histopathological changes in corneal and conjunctival tissues were observed using hematoxylin and eosin (HE) and periodic acid-Schiff (PAS) staining. Protein expression levels of key inflammatory markers and signaling pathway targets were assessed via immunohistochemistry, ELISA, and Western blotting.

Results: Compared to the control group, the model group showed significant reductions in SIT and increases in CFS scores, alongside structural disorganization of corneal/conjunctival tissues, decreased conjunctival goblet cell (CGC) numbers, and elevated expression of inflammatory markers [interleukin (IL)-1β, IL-6, tumor necrosis factor-alpha (TNF-α), matrix metalloproteinase-9 (MMP9)] and pathway proteins (TLR4, p-TAK1, p-p38MAPK; P<0.05). Treatment with QRY (low, medium, and high doses) and SB203580 significantly improved SIT scores, reduced CFS scores, restored corneoconjunctival structure, increased CGC numbers, and decreased expression levels of IL-1β, IL-6, TNF-α, MMP9, TLR4, p-TAK1, and p-p38MAPK proteins compared to the model group (P<0.05).

Conclusion: QRY may alleviate ocular surface inflammation associated with dry eye by inhibiting the TLR4/TAK1/p38MAPK signaling pathway, highlighting its potential therapeutic efficacy for dry eye.

Aim: To evaluate the efficacy of the Tecnis® Symfony® ZXR00 lens in achieving optimal visual outcomes for cataract surgery patients with axial length (AL) shorter than 24 mm.

Methods: A total of 21 subjects (37 eyes) were submitted to cataract surgery and implantation of Tecnis® Symfony® ZXR00 lens (Johnson & Johnson Vision) was assessed. Patients were examined at 5 m, 80 cm, and 40 cm for uncorrected distance visual acuity (UCDVA) and corrected distance visual acuity (CDVA), uncorrected intermediate (UCIVA), and uncorrected near visual acuity (UCNVA). Further, based on the optimal distance correction, the monocular defocusing curve in the range of +0.5 to -3.5 D was investigated. A simple patient-reported spectacle independence questionnaire (PRSIQ) was used to evaluate subjects' subjective feelings about their dependence on glasses at various distances. Multiple linear regression was employed to examine the association amony intraocular lenses (IOLs) diopter, AL, corneal curvature, anterior chamber depth, mean manifest refractive spherical equivalent, pupil, pupil/scan, target refraction, and near vision (logMAR).

Results: The study demonstrated enhanced UCNVA alongside comparable distant vision and UCIVA outcomes in eyes with AL shorter than 24 mm. Mean post-operative UCDVA significantly improved from preoperative levels 0.530±0.406 (P=0.000). Notably, 83.3% of eyes achieved 0.01 logMAR in UCNVA. Five unilateral cases with blended IOL implantation also showed satisfactory visual acuity and satisfaction. The 90.5% (19/21) achieved spectacle independence. The average score for self-reported spectacle-independence on the PRSIQ was 3.52 with a standard deviation of 0.98. The results of the regression analysis revealed that one predictor, the pupil/scan accounted for 27.6% of the variation in near vision [logMAR; F(1,35)=13.33, P<0.01].

Conclusion: The results affirm the effectiveness of the Tecnis® Symfony® ZXR00 lens in enhancing visual outcomes for cataract surgery patients with AL shorter than 24 mm. Additionally, the pupil/scan emerges as a critical factor influencing postoperative near vision.

Aim: To develop a traditional Chinese medicine (TCM) knowledge graph (KG) for diabetic retinopathy (DR) diagnosis and treatment by integrating literature and medical records, thereby enhancing TCM knowledge accessibility and providing innovative approaches for TCM inheritance and DR management.

Methods: First, a KG framework was established with a schema-layer design. Second, high-quality literature and electronic medical records served as data sources. Named entity recognition was performed using the ALBERT-BiLSTM-CRF model, and semantic relationships were curated by domain experts. Third, knowledge fusion was mainly achieved through an alias library. Subsequently, the data layer was mapped to the schema layer to refine the KG, and knowledge was stored in Neo4j. Finally, exploratory work on intelligent question answering was conducted based on the constructed KG.

Results: In Neo4j, a KG for TCM diagnosis and treatment was constructed, incorporating 6 types of labels, 5 types of relationships, 5 types of attributes, 822 nodes, and 1,318 relationship instances. This systematic KG supports logical reasoning and intelligent question answering. The question answering model achieved a precision of 95%, a recall of 95%, and a weighted F1-score of 95%.

Conclusion: This study proposes a semi-automatic knowledge-mapping scheme to balance integration efficiency and accuracy. Clinical data-driven entity and relationship construction enables digital dialectical reasoning. Exploratory applications show the KG's potential in intelligent question answering, providing new insights for TCM health management.

Aim: To evaluate the efficacy and safety of conbercept combined with 577 nm subthreshold micropulse laser (STML) for treatment of diabetic macular edema (DME).

Methods: A retrospective study was conducted. From October 2022 to March 2024, 72 patients diagnosed with DME at the outpatient clinic were enrolled. The patients were divided into two groups: the simple group (treated with conbercept alone) and the combination group (treated with 577 nm STML combined with conbercept). The following itmes were compared between the two groups: best corrected visual acuity (BCVA), central macular thickness (CMT), foveal avascular zone (FAZ), vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), retinal mean sensitivity (RMS), injection numbers, and the number of cases with adverse effects.

Results: The mean age of patients was 57.13±8.76 (range 34-77)y with DR history of 0.89±0.55y. With the progression of treatment, both groups showed significant improvements in BCVA, CMT, DCP vessel density, and RMS compared to baselines (all, P<0.05). At 3 and 6mo after treatment, the combination group exhibited significantly better outcomes in BCVA, CMT, DCP vessel density, and RMS than the simple group (P<0.05). During the treatment period, neither group showed significant improvements in FAZ and SCP vessel density (P>0.05), and no significant differences in FAZ and SCP vessel density were observed between the two groups (P>0.05). The average number of injections required in the combination group was lower than that in the simple group (3.33±0.68 vs 4.06±0.96, P<0.05). No other serious ophthalmic adverse events were observed in either group.

Conclusion: Conbercept combined with STML has better outcomes for treatment of DME and less intravitreal injections compared to conbercept monotherapy.