Comparison of OCT and OCTA manifestations among untreated PCV, neovascular AMD, and CSC in Chinese population

AIM: To compare the qualitative and quantitative features among untreated polypoidal choroidal vasculopathy(PCV), neovascular age-related macular degeneration(nv-AMD) and central serous chorioretinopathy(CSC) using optical coherence tomography(OCT) and OCT angiography(OCTA).METHODS: This retrospective study included 16 eyes with thin-choroid PCV, 18 eyes with thick-choroid PCV, 16 eyes with nv-AMD and 17 eyes with CSC, respectively. The indicators were obtained by OCT and OCTA.RESULTS: Sub-foveal choroidal thickness(SFCT) in CSC was thicker compared to other groups(all P<0.05). SFCT in nv-AMD was thicker compared to thin-choroid PCV, but thinner compared with thick-choroid PCV(both P<0.05). As the ratio of thickness of Haller's layer to thickness of SFCT, which of thin-choroid PCV was significantly higher than CSC(P<0.001). Likewise, thick-choroid PCV had significantly higher ratio than nv-AMD(P=0.016) or CSC(P<0.001). There were differences among them in pigment epithelium detachment(PED). The whole-superficial retinal vessel density(RVD), deep RVD and choroidal capillary vessel density(CCVD) in CSC were significantly higher compared to other three groups, respectively(all P<0.05). The whole CCVD in nv-AMD was higher compared to thick-choroid PCV(P=0.032). Cross-sectional local angiographic form was 87.50%, 83.33%, 0 and 35.29% in thin-choroid PCV, thickchoroid PCV, nv-AMD and CSC, respectively. Cross-sectional diffuse angiographic form was 12.50%, 16.67%, 100% and 5.88% in thin-choroid PCV, thick-choroid PCV, nv-AMD and CSC, respectively.CONCLUSION: Combination of OCT and OCTA can effectively observe the significant alterations existed in PCV, CSC and nv-AMD, and there are distinctive differences among them. The pathogenesis is not exactly the same between PCV and nv-AMD, or PCV and CSC.     

Early visual function outcomes of topography-guided FS-LASIK and SMILE in treatment of myopia and myopic astigmatism

AIM: To compare the quality outcomes of vision at early phase after topography-guided femtosecond laser-assisted in situ keratomileusis(FS-LASIK-CV) and small incision lenticule extraction(SMILE) in treatment of myopia and myopic astigmatism.METHODS: Retrospective comparative analysis of 49 patients that underwent FS-LASIK(n=23) or SMILE(n=26) procedure for myopia and myopic astigmatism between April and September in 2019. Pre-and postoperative uncorrected visual acuity(UCVA), spherical equivalent refraction(SEQ), cylindrical refraction, contrast sensitivity function(CSF), and corneal higher-order aberrations(HOAs) were evaluated. Independent t-test was used for inter-group comparison, while repeated measures ANOVA was used to analyze changes at different time points. RESULTS: In both groups, 100% of the eyes obtained a UCVA of 20/20 or better at 1 wk, 1, and 3 mo postoperatively. At 1 d and 3 mo postoperatively, UCVA was better in FS-LASIKCV group than in SMILE group. At 1 wk postoperatively, SEQ was lower in SMILE group than in FS-LASIK-CV group(P=0.006). At 3 mo postoperatively, the SEQ reached target refraction in both groups. The residual astigmatism was reduced in both groups without intergroup difference(P>0.05). At 3 mo postoperatively, the spherical aberration and coma under 6 mm pupil size were higher than preoperative levels in both groups(P<0.05). However, the increase in the corneal HOAs in the FS-LASIK-CV group was less than the SMILE group(P<0.05). At 3 mo postoperatively, the log CS were better than preoperative levels under scotopic conditions without glare and scotopic conditions with glare in both groups(P<0.05). At 1 and 3 mo postoperatively, under scotopic conditions without glare and scotopic conditions with glare, FS-LASIK-CV group showed more improvement in log CS at two spatial frequencies(12.0 c/d and 18.0 c/d;P<0.05).CONCLUSION: Both FS-LASIK-CV and SMILE demonstrate to be safe, effective, and predictable in treatment of myopia and myopic astigmatism. Early postoperative improvement in UCVA and CSF at high spatial frequency under scotopic conditions were better after FS-LASIK-CV than SMILE.     

Exploratory study of non-invasive, high-resolution functional macular imaging in subjects with diabetic retinopathy

AIM:To evaluate a high-resolution functional imaging device that yields quantitative data regarding macular blood flow and capillary network features in eyes with diabetic retinopathy(DR).METHODS:Prospective,cross-sectional comparative case-series in which blood flow velocities(BFVs)and noninvasive capillary perfusion maps(nCPMs)in macular vessels were measured in patients with DR and in healthy controls using the Retinal Functional Imager(RFI)device.RESULTS:A total of 27 eyes of 21 subjects were studied[9 eyes nonproliferative diabetic retinopathy(NPDR),9 eyes proliferative diabetic retinopathy(PDR)and 9 controls].All diabetic patients were type 2.All patients with NPDR and 5 eyes with PDR also had diabetic macular edema(DME).The NPDR group included eyes with severe(n=3)and moderate NPDR(n=6),and were symptomatic.A significant decrease in venular BFVs was observed in the macular region of PDR eyes when compared to controls(2.61±0.6 mm/s and 2.92±0.72 mm/s in PDR and controls,respectively,P=0.019)as well as PDR eyes with DME compared to NPDR eyes(2.36±0.51 mm/s and 2.94±1.09 mm/s in PDR with DME and NPDR,respectively,P=0.01).CONCLUSION:The RFI,a non-invasive imaging tool,provides high-resolution functional imaging of the retinal microvasculature and quantitative measurement of BFVs in visually impaired DR patients.The isolated diminish venular BFVs in PDR eyes compared to healthy eyes and PDR eyes with DME in comparison to NPDR eyes may indicate the possibility of more retinal vein compromise than suspected in advanced DR.     

Laser therapy versus intravitreal injection of anti-VEGF agents in monotherapy of ROP:a Meta-analysis

AIM:To compare the efficacy and safety between laser therapy and anti-vascular endothelial growth factor(VEGF)agents intravitreal injection monotherapy in type-1 retinopathy of prematurity(ROP)and aggressive posterior retinopathy of prematurity(APROP).METHODS:A systematic literature search was performed in PubMed,Cochrane Library,and Embase for original comparable studies.We included studies that compare laser therapy and intravitreal injections of anti-VEGF agents monotherapy in ROP regardless of languages and publication types.RESULTS:Complication incidence was significantly higher in laser therapy group(OR:0.38;95%CI:0.19-0.75;P=0.005).Spherical equivalent(SE)was higher in laser therapy[weighted mean difference(WMD):2.40,95%CI:0.88-3.93;P=0.002].The time between treatment and retreatment was longer in laser therapy group(WMD:8.45,95%CI:5.35-11.55;P<0.00001).Recurrence incidence(OR:0.97;95%CI:0.45-2.09;P=0.93)and retreatment incidence(OR:1.24;95%CI:0.56-2.73;P=0.59)were similar in two approaches.Subgroup analysis between type-1 ROP and APROP was not significant except SE reported in the included studies(P<0.0001).CONCLUSION:This Meta-analysis outcome indicates anti-VEGF agents are as effective as laser treatment,and safer than laser in type-1 ROP and APROP.The degree of myopia in APROP is higher than type-1 ROP.More randomized controlled trials in large sample size should be conducted in the future.     

圆锥角膜中细胞凋亡及Fas-L蛋白的表达

目的 探讨凋亡与圆锥角膜发病的关系及凋亡相关蛋白Fas-L的表达.方法 对20例圆锥角膜及5例正常角膜用原位末端标记法(TUNEL)检测凋亡,用免疫组织化学SP法检测Fas-L蛋白的表达;透射电镜观察凋亡细胞的形态学变化.结果 TUNEL染色示圆锥角膜组中上皮层、基质层及内皮层中细胞凋亡与正常角膜组比较差异均有统计学意义(P＜0.05);免疫组织化学示圆锥角膜组与正常角膜组基质层间Fas-L表达比较差异有统计学意义(P＜0.05);透射电镜可见圆锥角膜中存在凋亡特征的细胞.结论 圆锥角膜中存在凋亡,Fas-L蛋白的表达存在异常,Fas-FasL系统可能在圆锥角膜细胞凋亡中发挥了重要作用.     

Predictors of angle widening after laser iridotomy in Chinese patients with primary angle-closure suspect using ultrasound biomicroscopy

AIM:To assess the predictive value of baseline parameters of ultrasound biomicroscopy(UBM) for angle widening after prophylactic laser peripheral iridotomy(LPI) in patients with primary angle-closure suspect(PACS).METHODS:Angle-opening distance(AOD),trabecular iris angle(TIA),iris thickness,trabecular-ciliary process angle,and trabecular-ciliary process distance were measured using UBM performed before and two weeks after LPI.Iris convexity(IC),iris insertion,angulation,and ciliary body(CB) size and position were graded.Uni-and multivariate regression analyses were used to determine factors predicting the change in AOD(ΔAOD500,calculated as an angle width change before and after LPI) in all quadrants and in subgroup quadrants based on IC.RESULTS:In 94 eyes of 94 patients with PACS,LPI led to angle widening with increases in AOD500 and TIA(P<0.01).Multivariable regression analysis showed that IC(P<0.001),CB position(P=0.007) and iris insertion(P=0.049) were significantly predictive for ΔAOD500.All quadrants were categorized into extreme IC(27.8%),moderate IC(62.3%),and absent IC(9.9%) subgroups.The AOD500 increased by 220% and no other predictive factor was found in the extreme IC quadrants.The AOD500 increased by 55%,and baseline iris angulation was predictive for smaller changes in ΔAOD500 in the moderate IC quadrants.CONCLUSION:In PACS patients,quadrants with greater iris bowing predict substantial angle widening after LPI.Quadrants with a flatter iris,anteriorly positioned CB,and basal iris insertion are associated with less angle widening after LPI.Quadrants with iris angulation as well as a flatter iris configuration predict a smaller angle change after LPI.     

Clinical outcomes of transepithelial photorefractive keratectomy versus femtosecond laser assisted keratomileusis for correction of high myopia in South Egyptian population

AIM: To evaluate the safety and efficacy of transepithelial photorefractive keratectomy(t-PRK) with adjuvant mitomycin C(MMC) versus femtosecond laser assisted keratomileusis(Femto-LASIK) in correction of high myopia.METHODS: Prospective randomized comparative study including 156 eyes of 156 patients with high myopia and a spherical equivalent refraction(SER) <-6.00 D. They were divided randomly into two groups: Group A included 72 eyes treated with t-PRK with adjuvant MMC and Group B included 84 eyes treated with Femto-LASIK. Visual acuity, SER, corneal topography, pachymetry and keratometry were assessed for 12 mo postoperatively.RESULTS: The preoperative mean SER was-8.86±1.81 and-9.25±1.70 D in t-PRK MMC group and Femto-LASIK respectively(P=0.99) which improved to-0.65±0.43 D and-0.69±0.50 D at 12 mo follow up. Mean SER remained stable during the 12 mo of follow-up, with no statistically significant difference between the two groups(P=0.64). In t-PRK MMC group, only six eyes needed retreatment after six months of follow up. And two eyes showed haze(one reversible haze grade 2, while the other had dense irreversible haze grade 4).CONCLUSION: t-PRK MMC provides safe and satisfactory visual outcomes and acceptable risk as Femto-LASIK in patients with high myopia.     

Relationship between intraocular pressure and parameters of obesity in ocular hypertension

AIM:To evaluate the correlation between intraocular pressure(IOP)and various obesity-related health factors in patients with ocular hypertension in Korea.METHODS:A total of 40850 subjects underwent age,sex,body weight,and height assessments and automated multiphasic tests,including non-contact tonometry,automated perimetry,fundus photography,systolic/diastolic blood pressure measurement,and evaluation of obesity-related health parameters such as obesity index,body mass index(BMI),a body shape index(ABSI),and waist-to-height ratio(WtHR).Subjects were divided into ocular hypertension group and normal IOP group according to IOP after matching of age and sex.RESULTS:Of 40850 participants,1515(3.7%)had ocular hypertension,and 1515 with normal IOP were selected as controls using propensity score matching.The mean IOP of control group was 15.3±2.3 mm Hg,compared with 23.3±1.6 mm Hg in ocular hypertension group.Height,obesity index,BMI,and WtHR in the ocular hypertension group were significantly higher than in the normal IOP group(P<0.001,P<0.001,P=0.009,P=0.002).IOP of ocular hypertension was positively correlated with obesity index(P=0.027)and BMI(P=0.016),whereas IOP of control was positively correlated with blood pressure(P<0.001,P=0.002),obesity index(P<0.001),BMI(P<0.001),and WHtR(P=0.002).Systolic blood pressure(β=0.022,P<0.001)and body weight(β=0.016,P=0.02)were precursors of IOP in normal subjects,but sex(male;β=-0.231,P=0.008)and obesity index(β=-0.007,P=0.017)were precursors of ocular hypertension according to multiple regression analysis.CONCLUSION:Among various obesity-related health parameters,obesity index is the best indicator for further increase in IOP in ocular hypertension group.     

散光视标检查与散光轴位关系的定量推导

目的 定量推导散光视标检查与散光轴位之间的关系.方法 根据光学和数学的原理,从点光源成像入手,逐步定量地推导被检者对散光视标的辨认结果和散光轴位之间的关系.结果 被检者看到的最清晰散光视标的时钟钟点数乘以30°,即为被检者的散光轴位.或者被检者看到的最不清晰的散光视标的时钟钟点数加上3乘以30°,亦为被检者的散光轴位.结论 被检者对散光视标辨认结果和散光轴位之间关系的定量推导有助于正确的理解和临床应用.     

斜视对心理的影响

斜视不但影响患者的视功能、容貌,对患者的心理影响也是明显的.主要表现在斜视患者普遍存在抑郁、低自尊、社交焦虑和就业方面.另外,斜视患儿父母也因其孩子的影响而存在抑郁、紧张、焦虑.对年幼患儿斜视手术可以有效地改变他们的视功能,提高其适应社会的能力.对青少年和成年人斜视手术可改善其容貌,提高自尊水平,减少受到的社会歧视,减轻社交焦虑,更好的获得就业.     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.