International Ophthalmology最新文献

Purpose: Retinoblastoma (RB) is a common primary intraocular cancer developed in early childhood. The N6-methyladenosine (m⁶A) modification of long non-coding RNAs (lncRNAs) have been reported to participate in tumorigenesis. However, the study on the m⁶A modification of lncRNA in RB is still limited. This study proposed to reveal the role of lncRNA LINC00340 in RB depending on m⁶A modification.

Methods: The levels of LINC00340 and methyltransferase-like 14 (METTL14) were detected using qRT-PCR. The effects of LINC00340 interacting with METTL14 on RB cells were assessed by CCK8, colony formation, and flow cytometry assays. The changes of proteins associated with Notch signaling pathway were detected using western blotting. The regulatory mechanism of LINC00340 interacting with METTL14 in RB cells was confirmed by MeRIP, qRT-PCR, and actinomycin D treatment assays.

Results: The expression of LINC00340 and METTL14 in RB samples were elevated, as well as their levels in RB samples showed the positive correlation. Silencing LINC00340 in RB cells could impair RB cell growth and enhance apoptosis via activating Notch signaling pathway, but overexpressing LINC00340 in RB cells showed the opposite effects. In addition, upregulating METTL14 effectively relieved the repressive effects of silencing LINC00340 on RB cells due to METTL14-mediated m⁶A modification of LINC00340.

Conclusions: The findings of study reveal that METTL14-mediated m⁶A modification of LINC00340 exerts oncogenic function in RB via Notch signaling pathway, which may uncover a novel molecular mechanism driving RB progression and identify a potential therapeutic target for RB.

Purpose: To determine the practice patterns and preferences in the management of age-related macular degeneration (AMD) among vitreoretinal surgeons in the Philippines.

Methods: This is a descriptive cross-sectional study. A validated online survey regarding practices in AMD management was sent to the members of the Vitreo-Retina Society of the Philippines (VRSP). Data were analyzed using frequency and percent distributions.

Results: A total of 114 vitreoretinal surgeons participated in the study. Majority (97.4%) inquired about patients' smoking habits and advised cessation (99.1%). Dietary advice (94.7%) focused on omega-3-rich foods and green, leafy vegetables. Oral antioxidant supplements were prescribed for unilateral intermediate AMD (83.3%), with the age-related eye disease studies formula most commonly used (25.7%). Anti-vascular endothelial growth factor (anti-VEGF) was preferred for subfoveal (99.1%), juxtafoveal (94.7%), and extrafoveal (73.5%) choroidal neovascularization, with bevacizumab being the most frequently administered agent (72.6%) and aflibercept (83.2%) the most preferred due to cost considerations. The treat-and-extend protocol was followed by 58.4%, while 38.9% used a pro re nata approach. Treatment response was primarily evaluated by fluid reduction on optical coherence tomography, with intraretinal fluid being the most critical (48.7%). Most surgeons (86.7%) switched anti-VEGF agents for poor response, and 80.5% did so when no response was seen. Referral to low vision specialists was most often based on difficulty performing daily activities regardless of visual acuity.

Conclusion: Real-world practice patterns and preferences of the members of the VRSP generally align with globally recognized management standards for AMD. They displayed remarkable knowledge and attitudes with regards to smoking, diet, and nutrition in relation to AMD care. Anti-VEGF drugs have been used widely for neovascular AMD in accordance with international guidelines. A significant proportion acknowledge the advantages of referral to a low vision specialist.

Purpose: To evaluate the efficiency and safety profiles of a technique of simultaneous reconstruction of traumatic lacrimal duct obstruction and medial canthus deformity using micro-anchors.

Methods: A retrospective interventional study was performed from 2018 to 2022 on 26 consecutive patients who presented with medial canthal deformities and traumatic nasolacrimal duct obstruction. All patients underwent medial canthoplasty using micro-anchors combined with dacryocystorhinostomy to address the traumatic nasolacrimal duct obstruction. Preoperative and postoperative measurements of telecanthus, the superior or the inferior displacement of the medial canthal tendon (MCT), surgical technique of MCT fixation, advantages and limitations of using micro-anchors, functional and cosmetic outcomes were recorded and compared.

Results: Satisfactory and symmetrical medial canthal fixation outcomes were achieved in 96% (25/26) patients using the micro-anchors. The surgical technique was easy and offered secure and reliable reattachment of the MCT in long-term. The DCR surgery was anatomically and functionally patent in 92% (24/26) patients. One patient had unsatisfactory medial canthal outcomes where the canthus remained partly lateral, and inferior compared to the uninjured side. The two failures following DCR surgery were secondary to complete cicatricial closure and had persistent epiphora.

Conclusion: The present study noted that micro-anchors can correct the medial canthal deformity and leave more space for the DCR osteotomy simultaneously.

Purpose: To evaluate demographic and tomographical parameters in predicting treatment response following transepithelial iontophoresis-assisted corneal cross-linking (I-CXL) for progressive keratoconus.

Methods: Forty eyes (20 aged < 19 years and 20 aged ≥ 19 years) underwent I-CXL treatment between 2016 and 2022. Progression criteria based on the ABCD system, changes in asphericity (Q), demographic factors and keratoconus phenotypes were evaluated. Subjects were followed for 24 months after procedure.

Results: Sixty percent of participants were male. The mean age at the time of treatment was 21.0 ± 6.0 years. All tomographical values showed progression after 2 years of follow-up (p < 0.05), particularly during the first 6 months, except for anterior curvature. Within the ABCD grading system, we observed: A) an increase in anterior curvature, more evident with lower initial values; B) an increase in posterior curvature, more pronounced with higher initial values. Two years after I-CXL, 20% of subjects met progression criteria in two or more parameters, with 62.5% being under 19 years of age. Patients with a family history of corneal ectasia exhibited a mean KMax progression of 1.94D ± 1.88, (p = 0.046). Only phenotypes 3 and 4 showed progression. Although patients under 19 years showed greater progression in all tomographical variables at the end of the study, this difference was not statistically significant.

Conclusion: Treatment with I-CXL did not stop progression in the variables studied two years after the procedure in an effective manner, especially in patients younger than 19 years. A family history of corneal ectasia and subtype 4 keratoconus predicted a less favourable response to I-CXL.

Objective: The objective of this study is to assess the therapeutic efficacy of low-temperature plasma ablation (LTP) combined with drug treatment in the treatment of fungal keratitis (FK) caused by various pathogens, thereby establishing a clinical foundation for the use of LTP in treating FK.

Methods: A retrospective study was performed, including 76 patients (76 eyes) with FK diagnosed at the Affiliated Eye Hospital of Nanchang University. The patients were categorized into the Fusarium group, Alternaria group, Aspergillus group, and other genus groups based on positive results from biological cultures. Key clinical parameters, including best-corrected visual acuity (BCVA), maximum ulcer lesion diameter, and healing grades, were assessed and compared at baseline (pre-treatment), on postoperative day 3, and at postoperative week 3.

Results: The study demonstrated that the BCVA (LogMAR) of all patients revealed no significant differences at postoperative day 3 (F = 2.54, p = 0.063) and week 3 (F = 1.86, p = 0.143). Although BCVA improved to varying degrees compared to preoperative levels, the changes were not statistically significant (p > 0.05). After treatment with LTP combined with pharmacotherapy across all four groups, an average of 53 patients (69.74%) achieved grade I healing, with the group effect being nonsignificant (F = 2.85, p = 0.071), while the effect of time post-treatment was significant (F = 67.85, p < 0.001). Additionally, the corneal scar diameter at postoperative week 3 was significantly smaller compared to the preoperative lesion diameter (p < 0.05). Multiple comparisons revealed significant differences in scar diameter among patients with grade I healing at postoperative week 3 (F = 3.48, p = 0.023), with notable differences observed between the Alternaria and Fusarium groups (p = 0.017). The average rate of grade III healing, defined by the occurrence of corneal perforation and/or the need for therapeutic penetrating keratoplasty, was 7.89%.

Conclusion: Low-temperature plasma ablation demonstrates effective therapeutic outcomes for FK caused by various pathogens that are unresponsive to pharmacological treatments, with no significant complications.

Purpose: To compare clinical findings and visual outcomes of vitreous hemorrhage (VH) associated with uveitis in adults versus children.

Methods: A retrospective comparative study.

Results: There were 36 adults (44 eyes) and 10 children (12 eyes). Median age was 35 years in the adult group and 9.5 years in the pediatric group. VH was the presenting manifestation of the underlying uveitis in 45.7% of patients. VH in the adult group was more frequently associated with vascular sheathing, retinal hemorrhages, and extensive peripheral retinal ischemia on fluorescein angiography (FA), whereas VH in the pediatric group was associated with a significantly lower presenting visual acuity, and more frequently with vitritis and non-occlusive retinal vasculitis with fern-like retinal capillaritis. The most common source of bleeding was ischemia-driven retinal or optic disc neovascularization in the adult group (81.8%, p ≤ 0.001) and inflammation-driven optic disc neovascularization in the pediatric group (66.6%, p ≤ 0.001). A retinal vasoproliferative tumor was the cause of VH in one child (1.8%). Tuberculosis and Behçet's uveitis were the most common etiologies of uveitis in the adult group. Idiopathic intermediate uveitis/pars planitis was the leading cause of VH in the pediatric group. The mean final visual acuity was significantly higher in the pediatric group (20/25) than in the adult group (20/50) (p = 0.045).

Conclusions: VH associated with uveitis has a distinctive clinical and etiological profile between adults and children. The main source of bleeding was ischemia-driven neovascularization in adults and inflammation-driven neovascularization in children.

Introduction: The aim of this study is to determine the best cut-off value for the Standardized Patient Evaluation of Eye Dryness Portuguese version questionnaire and verify possible differences between the questionnaire score and different age groups.

Methods: The clinical validation of the Standardized Patient Evaluation of Eye Dryness Portuguese version was performed by completing this and the Ocular Surface Disease Index in Portuguese version questionnaire, in 180 volunteers (68.9% female), with an age range of 19-96 years.

Results: An excellent degree of reliability was found between the Standardized Patient Evaluation of Eye Dryness Portuguese version and the Ocular Surface Disease Index Portuguese version questionnaires (Cronbach's Alpha = 0.824). The Receiver Operating Characteristic curve analysis revealed a cut-off of 8 points (Sensitivity of 71.2% and Specificity of 71%). Furthermore, the area under the curve of the Receiver Operating Characteristic curve was 0.813, indicating that Standardized Patient Evaluation of Eye Dryness Portuguese version questionnaire is a good diagnostic tool and interchangeable with the Ocular Surface Disease Index questionnaire.

Conclusion: The Standardized Patient Evaluation of Eye Dryness Portuguese version questionnaire is a reliable tool for the detection of dry eye symptoms in the Portuguese population with a broad age range.

Purpose: To explore the relationship between dry eye disease and type 1 diabetes mellitus (DM) and also to identify whether diabetic peripheral neuropathy (DPN) was a significant predictor for the development of dry eye disease.

Materials and methods: This prospective cross sectional study involved patients with type 1 DM and aged- and sex-matched healthy controls. All of the participants underwent dry eye tests including meibomian gland function. Based on neurologic examination and electromyography findings, diabetic patients were grouped as DPN + and DPN-. All findings were compared and predictive factors for dry eye disease were identified.

Results: Of the 97 patients with type 1 DM, 42 (43.3%) were diagnosed as DPN. In patients with DM, there was a significant increase in the ocular surface disease index, corneal surface staining, eyelid margin abnormality and meibomian gland dysfunction and a significant decrease in tear break-up time and Schirmer's I test (p < 0.05). Measurements of dry eye tests were more severe with the presence of DPN (p < 0.05). Age of the patients, duration of DM and HbA1c level were significantly correlated with ocular surface and meibomian gland dysfunction parameters (p < 0.05). Age of the patients (p < 0.001), duration of DM (p = 0.001), HbA1c level (p = 0.036) and presence of DPN (p < 0.001) were found to be the independent and significant predictors of dry eye disease.

Conclusion: Type 1 DM was found to be significantly associated with ocular surface abnormalities including meibomian gland dysfunction. Furthermore, age of the patients, duration of DM, HbA1c level and presence of DPN were predictive factors of dry eye disease in type 1 DM.

Purpose: To evaluate the efficacy of early pars plana vitrectomy (PPV) and silicone oil (SO) tamponade for treating acute post-phacoemulsification infectious endophthalmitis.

Methods: This retrospective study included 44 eyes of 44 patients who developed early endophthalmitis after uneventful phacoemulsification. PPV with SO tamponade was performed within 24 h of presentation.

Results: A significant improvement in logMAR visual acuity (VA) was reported in our patients; (2.595 ± 0.249 at baseline compared to 1.052 ± 0.462 at final visit), with P value 0.0001. SO was removed in all cases after 4-9 months (6 ± 1.3) and all patients continued follow-up for at least 6 months after SO removal (15.4 ± 6.5). Postoperative complications included; three eyes (6.8%) developing severe proliferative vitreoretinopathy (PVR), four eyes (9.1%) developing inferior retinal detachment (RD) under SO, Two eyes (4.5%) developing pupillary block glaucoma and two eyes (4.5%) suffered from recurrent RD after SO removal.

Conclusion: Early PPV with SO tamponade for the treatment of acute endophthalmitis after phacoemulsification has good visual outcomes and lower complication rates if performed early within 24 h of patient presentation.

Purpose: To study the clinical and structural manifestations of persistent pupillary membranes (PPM) using light and electron microscopy.

Materials and methods: This descriptive case series study included 32 children (38 eyes) with different clinical PPM types. The cases were collected between 2005 and 2023. The age of the patients ranged from 7 months to 13 years, with a mean age of 3 ± 2.6 years. All children underwent standard ophthalmological examinations, including biomicroscopy, keratometry, gonioscopy, ophthalmoscopy, tonometry, visometry, ultrasonic biometry, scanning, and photo and video recording. Surgical removal of PPM was performed in 15 children (17 eyes), and the removed PPMs were histologically and electron microscopically studied.

Results: The PPMs were of different sizes, configurations, and volumes. The vast majority, 25 children (29 eyes, 76.3%), had type II PPM with iridolenticular attachment (Duke-Elder classification, 1964). Six children (8 eyes, 21.1%) had type I PPMs with iris-to-iris attachment. In one case (one eye, 2.67%), a combination of type I and type II PPM was observed. In the eyes with PPM, microphthalmia and microcornea were observed in 34.2% and 23.7% of cases, respectively. PPM affected the size and configuration of the pupil in 44.76% of cases and the anterior chamber angle structure in 26.3% of cases. The lens remained transparent in 84.2% of the cases. Congenital cataracts were observed in 15.89%. Visual acuity in the eyes with PPM varied from light perception to 0.4 logMAR. In 50.0% of cases, significant visual loss occurred in type II PPM. Histomorphological and electron microscopic studies showed that PPM was the remnant of the tunica vasculosa lentis, had a mesodermal origin, and did not penetrate the anterior lens capsule.

Conclusion: For the first time, the clinical features of PPM were analyzed in a significantly large number of cases, and the analysis showed that PPMs with iridolenticular attachment were dominant. They were of different sizes and configurations and had a dense fit to the lens, causing significant visual loss and thus requiring surgical removal. In almost half of the cases, PPM caused pupil narrowing, decentration, and deformation, whereas the crystalline lens remained transparent in most cases (84.2%).