Fundus autofluorescence imaging of patients with idiopathic macular hole

AIM: To assess the visual outcomes of aspheric multifocal intraocular lenses (IOLs) compared with spherical multifocal IOL after cataract surgery.METHODS:Potential prospective controlled trials that comparing aspheric multifocal IOL implantation with spherical multifocal IOL group were extracted from the computer database. The statistical analysis was carried out using Stata 10 software. Standardized mean differences with 95% confidence intervals (CIs) were calculated for continuous variables. The pooled estimates were computed in the use of a random-effects model.RESULTS:A systematic review identified five prospective nonrandomized controlled trials, including 178 aspheric multifocal IOL and 164 spherical multifocal IOL. There was no significant difference in uncorrected distance visual acuity (95%CI, -0.248 to 0.152;P=0.641) and uncorrected near visual acuity (95%CI, -0.210 to 0.428;P=0.504) between aspheric multifocal IOL and spherical multifocal IOL. Statistically significant differences were detected less spherical aberration in aspheric multifocal IOL (95%CI, -1.111 to -0.472; P＜0.001) when compared to spherical multifocal IOL. Spherical multifocal IOL showed a greater higher order aberration compared to the aspheric multifocal IOL (95%CI, -1.024 to-0.293; P＜0.001). Sensitivity analysis suggested that the results were relatively reliable.CONCLUSION:The overall findings indicated that aspheric multifocal IOL and spherical multifocal IOL provided similar visual acuity at near and distance. Patients implanted with aspheric multifocal IOL had less spherical aberration and higher order aberration than patients with spherical multifocal IOL. Further well-organized, prospective controlled trials involving larger patient numbers are needed.     

Comparative evaluation of rotational stability of toric IOLs with four-eyelet vs two-eyelet capsular tension rings in eyes with high myopia

AIM:To compare the rotational stability of Toric intraocular lens(IOLs)implantation combined with foureyelet or two-eyelet capsular tension rings(CTRs)in eyes with high myopia and cataract.METHODS:This prospective randomized controlled interventional study in cluded 33 eyes which had preoperative corneal astigmatism≥1.5 D and ocular axial length≥25.5 mm.These eyes were randomly divided into two groups to undergo phacoemulsification and toric IOL implantation with either four-eyelet CTR implantation(group A,n=16)or two-eyelet CTR implantation(group B,n=17).Uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),phoropter examination results,and toric IOL rotation degrees were tested 6 mo after the surgery.RESULTS:In both groups,the toric IOL was in the capsular sac 6 mo after surgery.The difference between the two groups in terms of visual outcome was not found to be statistically significant(P>0.05)at a follow-up of 6 mo.The mean residual astigmatism values were 0.56±0.22 D and 0.92±0.24 D in A and B groups,respectively(P<0.001).The mean rotation degree of IOL was 1.00°±0.73°in group A and 3.53°±1.46°in group B(P<0.001).CONCLUSION:In cataract patients with high myopia and astigmatism,four-eyelet CTR can effectively increase the rotation stability of toric IOLs,achieving the desired goal of correcting corneal astigmatism.     

双眼非动脉炎性前部缺血性视神经病变患者的临床特点和预后分析

目的：研究双眼非动脉炎性前部缺血性视神经病变(nonarteritic ischemic optic neuropathy, NAION)患者的临床特点及其预后的影响因素。

方法：回顾2006年以来我院收治的双眼发病NAION患者的临床资料,包括发病特点、治疗方法、人口统计学特征、病史、视功能指标(视力、视野)等,并对影响视功能预后的相关因素进行统计分析。

结果：研究共纳入61例(122眼)双眼NAION患者,其中男性39例,女性22例,平均年龄58.0±11.0岁,就诊时平均病程12.5mo(IQR 4.75～26.5),初诊时最佳矫正视力中位数为0.7 LogMAR(IQR 0.2～1.3)。就诊时38眼仍有不同程度视盘水肿,76眼视盘色淡或苍白。典型的视野缺损类型分别为下方近水平半盲(38眼)、鼻上方缺损(21眼)、鼻下方缺损(16眼)、上方近水平半盲(13眼),以及近管状视野(12眼)。纳入患者中31例伴有高血压、高血脂、糖尿病或其他心脑血管疾病。患者随访时间的中位数为12mo(IQR 6.0～23.5),随访期间视力中位数由0.7 LogMAR(IQR 0.2～1.3)提高至0.4 LogMAR(IQR 0.175～1.1),其中45眼(36.9%)的视力提高了2行或以上。男性患者和女性患者的视力比较,初诊时及随访后两者均无统计学差异(Z=-0.521,-1.600,P>0.05)。伴有心脑血管疾病的患者与不伴心脑血管疾病者比较,初诊时两组患者视力无统计学差异(Z=-1.103,P>0.05),但末次随访时不伴有心脑血管疾病的患者的视力明显优于伴心脑血管疾病的患者(Z=-2.090,P<0.05)。首发眼和后发病眼的末次随访视力均优于初诊视力(P=0.003,0.019),且首发眼的视力在随访期间的提高幅度高于后发病眼的视力提高幅度(分别为0.2 LogMAR及0.1 LogMAR),但差异尚无统计学意义(P=0.195)。

结论：本研究统计分析了双眼NAION患者的人口统计学特征、发病率、病史、视功能指标(视力、视野)等,现有随访数据表明,不伴心脑血管疾病的双眼NAION患者视力改善幅度优于患心脑血管疾病者,且首发眼视力预后可能优于后发病眼。但目前尚缺乏足够证据,仍需进一步研究。     

Factors affecting visual outcome of myopic choroidal neovascularization treated with verteporfin photodynamic therapy

AIM: To evaluate the visual outcomes of choroidal neovascularization (CNV) secondary to pathological myopia and the impact of novel risk factors affecting the final visual outcome.METHODS:Interventional case series of 18 consecutive patients with pathological myopia treated with photodynamic therapy (PDT). Inclusion criteria were spherical equivalent -6D or worse or features of pathological myopia on retinal examination. The main outcome measure was final best-corrected visual acuity (BCVA).RESULTS:Of 18 eyes, 13 (72.2%) avoided moderate visual loss (≥3 lines of LogMAR BCVA) and 5 eyes (27.8%) improved by at least 1 line after 1 year. Patients with LogMAR BCVA ≤0.3 (Snellen equivalent 20/40) at one year were younger than those with BCVA >0.3 (mean age 39.0 vs 61.6 years, P=0.001). A higher proportion of eyes with greatest linear dimension (GLD) of ≤1000µm avoided moderate visual loss (100% vs 50%, P=0.026). Among patients who were treated within 2 weeks of visual symptoms, 88.9% avoided the loss of 3 or more lines compared to 55.6% for those who presented later. The mean improvement in LogMAR BCVA of those with GLD ≤1000µm was +0.12 compared to a loss of 0.55 LogMAR units for those with GLD >1000µm (P=0.02). Visual outcomes were not associated with gender or refractive error.CONCLUSION: Good visual outcome in myopic CNV is associated with younger age, smaller lesion size and earlier initiation of treatment. These factors are relevant for ophthalmologists considering treatment options for myopic CNV.     

Diabetes onset at an earlier age and high HbA1c levels as risk factors of diabetic retinopathy

AIM:To assess the effect of age at diabetes onset and uncontrollable high Hb A1 c levels on the development of diabetic retinopathy(DR)among Chinese type 2 diabetes mellitus(DM)patients.METHODS:This was a cross-sectional survey of diabetic patients in Subei district,China.Data covering physical measurements,fasting blood-glucose(FBG),glycosylated hemoglobin(Hb A1 c),blood lipid,urinary albumin/creatinine ratio(UACR),ocular fundus examination,and diabetes treatment records were collected.An independent sample t-test were used to analyze differences.A Logistic regression analysis was applied to study the independent risk factors of DR.RESULTS:A total of 1282 patients with type 2 DM were enrolled,and 191 cases had DR(14.9%).The age at diabetes onset,education level,alcohol consumption,Hb A1 c level,UACR level,and hypoglycemic drugs were independent influencing factors for DR.The older the onset of diabetes,the less likely to develop DR(OR:0.958,95%CI:0.942-0.975,P=0.000).Patients were then divided in terms of age at diabetes onset as follows:<50 y,50-59 y,60-69 y,and≥70 y.Compared with diabetes onset age<50 y,50-59 y(OR:0.463,95%CI:0.306-0.699,P=0.000),60-69 y(OR:0.329,95%CI:0.203-0.535,P=0.000)and≥70 y(OR:0.232,95%CI:0.094-0.577,P=0.002)were at a lower risk of DR.The prevalence of DR was highest in patients with diabetes onset age<50 y(29.5%,P<0.05).The Hb A1 c level(8.67±1.97)%and proportion of insulin injection(52.5%)in patients with diabetes onset<40 y were higher than in patients with older diabetes onset age(P<0.05).CONCLUSION:Diabetes onset at an earlier age and uncontrollable high Hb A1 c level could be independent risk factors for DR.     

Cataract surgery in aged patients: phacoemul-sification or small-incision extracapsular cataract surgery

AIM: To evaluate the effects and safety of phacoemu- lsification (Phaco) or small-incision extracapsular cataract surgery (SICS) and intraocular lens (IOL) implantation for aged patients. METHODS: Totally 137 aged patients (149 eyes) underwent cataract operation in the case of stable systemic condition, the blood pressure less than 160/95mmHg, blood glucose less than 8mmol/L, and under the help of electrocardiogram surveillance by anesthesiologists during the operation. 106 aged patients (114 eyes) underwent Phaco while 31 aged patients (35 eyes) underwent SICS. The postoperative visual acuity, corneal endothelial cell loss, surgery time and major complications were observed and analyzed retrospectively. RESULTS: The best-corrected visual acuity(BCVA) of ≥0.6 was achieved in 135 eyes (92.6%) at 1 month postoperatively (χ2=259.730, P＜0.001). For aged patients, both Phaco and SICS could significantly improve visual acuity with no significant difference (χ2=4.535,P＞0.05). Postoperative corneal endothelial cell loss was 18.6%, in PHACO group, the rate was 18.5%; in SICS group, the rate was 19.0%, the difference of which was no significant (χ2=0.102, P>0.05). The surgery time was different in two groups. No severe complications occurred. CONCLUSION: Both Phaco and SICS combined with IOL implantation for aged patients are effective and safe. Before surgery, detailed physical examination should be performed. When the systemic condition is stable, cataract surgery for aged patients is safe.     

Real-world outcomes of two-year Conbercept therapy for diabetic macular edema

AIM: To evaluate the two-year outcomes of patients treated for diabetic macular edema(DME) with intravitreal Conbercept(IVC).METHODS: The clinical data of 30 DME patients(36 eyes) were retrospectively reviewed. The patients were treated with IVC for 3 mo. Additional IVC was given at subsequent monthly visits, if needed(3+PRN). The patients were followed up for 24 mo.RESULTS: The best-corrected visual acuity(BCVA) at 24 mo significantly increased(66.7±15.3 letters) in comparison with the baseline(54.4±15.4 letters, P<0.0001). The mean improvement in BCVA was 11.0±2.9 letters. At 24 mo, 44.1% of the eyes surveyed gained ≥15 letters, 52.9% of the eyes gained ≥10 letters, and 70.6% of the eyes gained ≥5 letters. No vision loss was noted in 96.8% of the eyes, and 5.9% of the eyes lost ≥5 letters, but ≤10 letters. The central retinal thickness(CRT) at 24 mo was significantly reduced(277.1±122.9 μm) in comparison with the baseline(510.9±186.1 μm, P<0.0001). At 24 mo, 43.3% of the patients had a CRT ≤250 μm. The mean number of injections over 24 mo was 10.6±2.0. No severe eye or systemic adverse events related to either the drug or injection were noted.CONCLUSION: IVC is safe and effective for the treatment of DME.     

Intravitreal injection of triamcinolone acetonide in nonarteritic anterior ischemic optic neuropathy

BackgroundSystemic corticosteroid may play a vital role in treating nonarteritic ischemic optic neuropathy (NAION). An intravitreal route provides the advantage of avoiding systemic side effects. In this study, we investigated the treatment result of intravitreal injection of acetonide (IVITA).MethodsWe retrospectively reviewed six patients with NAION who were treated with a single IVITA. The patients were followed monthly for 6 months.ResultsVisual acuity improved in three patients. One patient also had a better visual field at the 6^th month follow up. Two patients with more severe swelling of the optic disc initially did not gain better visual acuity. One patient with a pre-existing epiretinal membrane maintained stable visual acuity.ConclusionSome patients with NAION may improve with IVITA treatment. Further randomized controlled clinical trials are needed.     

Analysis of glistenings in hydrophobic acrylic intraocular lenses on visual performance

AIM:To assess patients’ visual performance with glistenings in one piece soft hydrophobic acrylic intraocular lenses (IOLs) (Alcon) 2 years postoperatively.METHODS:This cross section trial included 120 eyes with one piece IOL at 2 years postoperatively. Glistening was classified in 4 groups, ranging from 0 (none) to 3 (most evident) according to their severity in IOLs optics observed under a slit lamp. All eyes underwent a uncorrected and best-corrected visual acuity evaluation (UCVA and BCVA, LogMAR scale), a complete clinical examination, a contrast sensitivity (CS) evaluation by F.A.C.T chart, and a visual field test by Humphrey Field AnalyzerⅡ(HFA). One-way ANOVA was used for quantitative data, while Pearson χ² test was used for qualitative data to analyze the visual function of 4 glistening groups.RESULTS: Totally 120 eyes were enrolled with 30 eyes in each glistening group. There was no statistical correlation between glistening grades and patients’ age, IOLs power, postoperative UCVA and BCVA (P>0.05). Quantificationally, CS values among each group were not statistically different. However, qualitative analysis showed there were more eyes in grade 3 group than in grade 0 group having abnormally declined CS at high spatial frequency (10% vs 36.7% at 18 cpd, P=0.029; 6.7% vs 26.7% at 12 cpd, P=0.013). Mean deviation (MD) of the visual field test was -2.14±2.31, -1.97±2.23, -3.02±3.17, -4.12±3.38 in group 0 to 3 respectively. There was a significant decrease in the most serious glistenings group (P =0.018).CONCLUSION:Glistenings may potentially have an impact on contrast sensitivity at high spatial frequencyand MD in visual field test.     

Evaluation of a new nomogram for Ferrara ring segment implantation in keratoconus

AIM: To evaluate the short-term clinical outcomes of Ferrara rings in keratoconus using an optimized nomogram developed after several years of research and retrospective analysis of clinical data. METHODS: This prospective longitudinal non-comparative clinical trial evaluated 88 eyes of 88 patients (age 18-62y) with keratoconus diagnosis from two Spanish centers. Ferrara ring segment (AJL Ophthalmic) implantation was performed in all cases, using the mechanical procedure in 25 eyes (28.4%) and a femtosecond laser-assisted procedure in 63 eyes (71.6%). The ring segments implanted in each case were selected using a new optimized nomogram that considered variables such as anterior corneal asphericity and astigmatism or the discrepancy among astigmatism and coma orientations. Visual, refractive, corneal topographic, aberrometric, and pachymetric changes after surgery were evaluated during a 3-month follow-up. RESULTS: The implants induced a significant refractive change as well as an improvement in uncorrected (UDVA) and corrected distance visual acuity (CDVA; P<0.001). Postoperative CDVA of 0.10 logMAR or better was achieved in 28.4% and 46.5% of eyes, respectively. Two eyes (2.3%) lost two or more lines of CDVA whereas a total of 53.5% of eyes gained lines of CDVA. A significant central anterior and posterior corneal flattening was induced (P≤0.003), with a significant reduction of anterior (P<0.001) and posterior corneal astigmatisms (P=0.048), and a change in anterior asphericity (P<0.001). Total primary coma (6 mm pupil) change was also statistically significant (preoperative 3.66±3.04 µm vs postoperative 2.33±2.26 µm, P<0.001). No significant differences were found in the effect of ring segments between cases implanted using the mechanical and femtosecond techniques (P≥0.101). CONCLUSION: The implantation of Ferrara rings based on the nomogram evaluated is safe and effective for promoting a visual rehabilitation in keratoconus, with a relevant control of primary coma aberration.     

Comparison of effectiveness of silicone hydrogel contact lens and hydrogel contact lens in patients after LASEK

AIM: To conduct a comparative study of effectiveness of silicone hydrogel contact lens and hydrogel contact lens, which are used in patients after laser-assisted subepithelial keratomileusis (LASEK). METHODS: Sixty-three patients (121 eyes) with a spherical equivalent ≤-5.0 D were chosen after undergoing LASEK in 2012 at Guangdong General Hospital. They were randomly divided into 2 groups. The silicone hydrogel group included 32 cases (61 eyes) that wore silicone hydrogel contact lenses for 4-6d after the operation, while the hydrogel group included 31 cases (60 eyes) who wore hydrogel contact lenses for 4-6d after the operation. Patients’ self-reported postoperative symptoms (including pain, photophobia, tears, and foreign body sensation) were evaluated. The healing time of the corneal epithelium, the visual acuity of patients without contact lens after epithelial healing, and the incidence of delayed corneal epithelial shedding were also assessed. The follow-up time was 1mo. RESULTS: Postoperative symptoms were milder in the silicone hydrogel group than in the hydrogel group. There were significant differences in pain, foreign body sensation, and photophobia between the 2 groups (P<0.05), although there was no significant difference in postoperative tearing (P>0.05). The healing time of the corneal epithelium in the silicone hydrogel lens group was markedly shorter than that in the hydrogel group (4.07±0.25 vs 4.33±0.82d, t=2.43, P=0.02). Visual acuity without contact lenses after healing of the corneal epithelium was better in the silicone hydrogel group compared with the hydrogel group (χ2=7.76, P=0.02). There was no significant difference in the occurrence of delayed corneal epithelial shedding between the 2 groups (P>0.05). CONCLUSION: Patients with LASEK using silicon hydrogel contact lenses had less discomfort and shorter corneal epithelial healing time compared with those using hydrogel contact lenses, suggesting that silicon hydrogel contact lenses may be considered to be a better choice of bandage contact lens after LASEK.     

Factors affecting outcomes of corneal collagen crosslinking treatment

Purpose

To assess the effects of preoperative patient characteristics on clinical outcomes of corneal crosslinking (CXL) treatment in patients with progressive keratoconus.

Methods

This retrospective study comprised 96 eyes of 96 patients who had unilateral CXL treatment for progressive keratoconus. All patients underwent a complete ophthalmological examination and corneal topography at baseline and 1 year. Subgroup analyses were performed according to the age (<30 and≥30 years), gender, preoperative corrected distance visual acuity (CDVA, <0.3 and ≥0.3 logMAR (log of the minimum angle of resolution)), preoperative maximum keratometry (K, <54 and ≥54 D), baseline topographic cone location (central, paracentral, and peripheral), and preoperative thinnest pachymetry (<450 and ≥450 μm) to determine the associations between preoperative patient characteristics and outcomes (changes in visual acuity and maximum keratometry) of CXL treatment.

Results

In the entire study population, mean CDVA and maximum K significantly improved after CXL treatment (P<0.001). Patients with a preoperative CDVA of 20/40 Snellen equivalent or worse (≥0.3 logMAR) experienced more visual improvement after CXL treatment (P<0.001). However, an age ≥30 years and a baseline thinnest pachymetry less than 450 μm were found significantly associated with more flattening in maximum keratometry (P=0.024, P=0.005 respectively). Gender, preoperative maximum K, and baseline topographic cone location did not show significant effect on postoperative visual acuity and maximum keratometry (P>0.05).

Conclusions

In patients with progressive keratoconus, age, baseline visual acuity, and baseline thinnest pachymetry seem to affect the success of the CXL treatment.     

Comparison of correcting myopia and astigmatism with SMILE or FS-LASIK and postoperative higher-order aberrations

AIM:To compare the effect of myopia and astigmatism correction and postoperative change in higher-order aberration as results of receiving small-incision lenticule extraction(SMILE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS:A prospective and non-randomized controlled study was conducted.The subjects are divided into two groups according to different operations received:229 eyes of 116 patients in the SMILE group and 168 eyes of 86 patients in the FS-LASIK group.All subjects were followed up for 3 mo by monitoring their uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),spherical equivalent,higher-order aberrations,and the preoperative and postoperative complications.RESULTS:At 1 wk,1,and 3 mo post-surgery,224 eyes(97.8%),227 eyes(99.1%)and 229 eyes(100%)had UCVA≥20/20 in the SMILE group,while 165 eyes(98.2%),167 eyes(99.4%)and 167 eyes(99.4%)had UCVA≥20/20 in the FS-LASIK group,respectively(χ²=0.146,2.135,and 1.124;all P>0.05).BCVA reduction was not observed in both groups at 1 and 3 mo of post-surgery(χ²=0.734 and 1.898,P>0.05).There was no statistically significant difference in the spherical equivalent between the two groups at 1 and 3 mo post-surgery,though the percentage of the spherical equivalent within±0.50 D at 3 mo postsurgery was 98%in the SMILE group,which was higherthan that of the FS-LASIK group(92%,χ²=1.872,P>0.05).The root mean square(RMS)values of total high-order aberration,coma,and spherical aberration of the two groups increased significantly in the early postoperative period and decreased after 3 mo,but the values were still higher than the preoperative levels(P<0.05);there was no significant difference between the two groups in the RMS values of total higher-order aberrations and specific higherorder aberrations(P>0.05).The incidence of complications in the SMILE group was lower than that in the FS-LASIK group(χ²=14.52,P<0.05).CONCLUSION:SMILE and FS-LASIK can effectively treat myopia,significantly improve visual acuity,and increase the total high-order aberration,spherical aberration,and coma.The incidence of complications after SMILE is relatively low.     

Changes in Visual Function over Time in Koreans with Non-arteritic Anterior Ischaemic Optic Neuropathy

Abstract

Non-arteritic anterior ischaemic optic neuropathy (NAION) causes severe visual loss in elderly patients. However, there are not much data of clinical course of NAION in Asian patients. To evaluate changes in visual acuity and visual field defects associated with non-arteritic anterior ischaemic optic neuropathy (NAION) among Korean patients, the medical records of 50 eyes from 43 patients with NAION patients seen from 1989 to 2011 were reviewed. A significant change in visual acuity was defined as a three-line change in Snellen acuity. Visual field defects were evaluated with Goldmann perimetry. Changes in the visual field were evaluated using the grid method. Thirty-eight percent of eyes showed improvement, 54% showed no change, and 8% showed deterioration of visual acuity at the last follow-up. Thirty-four percent of eyes showed improvement, 54% showed no change, and 12% showed deterioration of the visual field at the last follow-up. Most improvement in visual acuity occurred during the first month after the initial visit and in visual field between the first and third months of follow-up. The prognosis of visual acuity in association with NAION was worse in Korean patients as compared with Western studies. However, improved prognosis of visual field defects might come from the use of different methods for evaluation of the visual field.     

Visual perceptions induced by intravitreous injections of therapeutic agents

Purpose

The purpose of this study was to conduct a questionnaire-based survey of subjective visual perceptions induced by intravitreous (IVT) injections of therapeutic agents.

Patients and methods

Patients undergoing an IVT injection of ranibizumab, pegaptanib sodium, or triamcinolone acetonide were administered a questionnaire in the immediate post-injection period and at 2 weeks of follow-up.

Results

In the immediate post-injection period (75 IVT injections, 75 eyes, 75 patients), lights and floaters were reported after 20 (27%) and 24 (32%) IVT injections, respectively. In comparison, at the 2-week follow-up, the incidence of reported lights (11; 15%) was similar (P>0.05), but the incidence of reported floaters was higher (48; 64% P=0.00). Subgroup analysis for various injection subgroups (no previous injection vsprevious injection(s) in the study eye; injections in study eyes with good VA (logarithm of minimal angle of resolution [logMAR] ≤0.3) vsmoderate VA (0.7 0.3) vspoor VA (logMAR ≥0.7); injections according to pharmacological agent (ranibizumab vspegaptanib vstriamcinolone acetonide); injections in study eyes with choroidal neovascularization (of various causes) vsstudy eyes with macular edema (of various causes); and injections in phakic vspseudophakic eyes) did not reveal any statistically significant associations. Visual perceptions experienced following 15% of IVT injections gave cause for concern to the patient (mean visual analog scale score (±SD): 4.5 (±1.7)), and in 64% of cases, the patients believed that preoperative counseling would have averted the concern.

Conclusions

Lights and floaters are frequent visual perceptions following IVT injections of therapeutic agents. They can give rise to concern that could be alleviated with preinjection counseling.     

Follow-Up of Nonarteritic Anterior Ischemic Optic Neuropathy With Optical Coherence Tomography Angiography

PurposeThe purpose of this study was to describe capillary changes in patients with nonarteritic anterior ischemic optic neuropathy (NAION) using optical coherence tomography-angiography (OCT-A) and correlate the results with best corrected visual acuity (BCVA), visual field, OCT retinal nerve fiber layer (RNFL), and combined thickness of ganglion cell and inner plexiform layers (GCIPL) thicknesses.MethodsWe enrolled 22 eyes with acute NAION and 30 normal control (NC) subjects in this study. Whole en face image vessel density (WiVD) was measured in the radial peripapillary capillary plexus (RPC), superficial capillary plexus (SCP), and deep vascular complex (DVC) using OCT-A. The examination was repeated at 1 (M1), 3 (M3), 6 (M6), and 9 (M9) months after presentation for NAION.ResultsThe initial RPC WiVD was significantly reduced in the acute NAION group compared to the NC group (P < 0.0001). Over the course of NAION follow-up, RPC WiVD was significantly reduced at M1 (P < 0.001 compared to M0) and M3 (P < 0.0001 compared to M1). However, there was no significant further decrease at M6 and M9. The initial SCP WiVD was significantly reduced in the NAION group compared to the NC group (P < 0.0001 for both). Over the course of NAION follow-up, a significant decrease was observed for SCP WiVD at M1 (P < 0.001 compared to M0), but no significant change was seen at M3, M6, or M9. DVC was normal in the NAION group. Correlations were found between GCIPL and SCP WiVD in the NAION acute phase (R = 0.604, P = 0.003) and in the M9 atrophic stage (R = 0.551, P = 0.009). At M9, RPC WiVD was correlated with BCVA (R = −0.562, P = 0.007), mean deviation (R = 0.518, P = 0.01), and RNFL (R = 0.655, P = 0.001).ConclusionsOver the course of NAION, OCT-A provided detailed visualization of retinal capillary plexus involvement.     

[Online First]Inhibition of TGF-β2-induced migration and epithelial-mesenchymal transition in ARPE-19 by sulforaphane

AIM: To investigate the effects of sulforaphane (SFN) on transforming growth factor (TGF)-β2 stimulated migration and epithelial-mesenchymal transition (EMT) in ARPE-19 cells. METHODS: ARPE-19 cells were cultured in the presence or absence of SFN or TGF-β2. SFN toxicity was assessed by performing a lactate dehydrogenase assay (LDH) and 3-(4,5-Dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assays, and cell migration was evaluated by Transwell migration assay. Actin stress fiber formation in ARPE-19 cells was determined using immunofluorescence analysis. Immunoblotting analysis was used to determine fibronectin and α-smooth muscle actin expressions along with the degree of Smad and Akt phosphorylation. RESULTS: SFN inhibited ARPE-19 migration. Additionally, SFN attenuated TGF-β2-induced appearance of actin stress fibers as well as fibronectin and α-smooth muscle actin expressions in these cells. SFN also hindered the TGF-β2-stimulated phosphorylation of Smad2, Smad3, and Akt. SFN showed no cytotoxicity towards ARPE-19 cells. CONCLUSION: SFN inhibite TGF-β2-stimulated migration and EMT in ARPE-19 cells, probably by preventing the establishment of actin stress fibers and Akt and Smad2/3 signaling.     

非动脉炎性前部缺血性视神经病变的电生理及临床特征分析

目的：对NAION患者的电生理及临床特征进行分析。

方法：选取本院2015-06/2016-06收治的68例81眼非动脉炎性前部缺血性视神经病变(non-arteritic anterior ischaemic optic neuropathy,NAION)患者作为研究对象,按照年龄分为对照组36例39眼(平均年龄50岁以下),观察组32例42眼(平均年龄50岁以上)。对两组患者的人口学特点、临床特点、相关危险因素、图形视觉诱发电位、视力等方面进行对比分析。

结果：对照组患者临床症状中,发病时有遮挡感、对侧眼受累比例均明显低于观察组患者,组间差异有统计学意义(P<0.05)。对照组患者1°空间频率和15''空间频率均明显优于观察组,组间差异有统计学意义(P<0.05)。对照组与观察组患者初始视力比较,差异无统计学意义(P>0.05)。对照组患者最终视力明显优于观察组患者,组间差异有统计学意义(P<0.05)。

结论：患有NAION的患者,其临床病症受年龄较大、发病时有遮挡感、对侧眼受累等因素影响,1°空间频率和15''空间频率延迟相对较严重,且最终视力并不十分良好。由此可见,对NAION患者进行电生理检查有助于进行病情的诊断,临床亦应该加强对NAION患者的随访,减少其患眼对侧眼的发病几率。     

可调节人工晶状体植入术后的视觉质量及拟调节力

目的:研究Tetraflex可调节人工晶状体(IOL)植入术后视力、调节幅度、对比敏感度及主观视觉功能的临床应用效果。方法:病例对照研究。选择2010-03/2012-12在我院接受白内障超声乳化摘除联合囊袋内IOL植入术的白内障患者48例72眼,其中23例35眼植入Tetraflex可调节IOL(Tetraflex组),25例37眼植入AcrySof SA60AT单焦点IOL(SA60AT组),对比研究两组患者术后1,3,6mo裸眼远视力、最佳矫正远视力、裸眼近视力、最佳矫正近视力、最佳矫正远视力下近视力、拟调节力、脱镜率以及患者满意度情况,采用主观移近法测量调节力。采用SPSS13.0统计软件包进行统计学处理。结果:术后随访期间,两组患者的裸眼远视力、最佳矫正近视力和最佳矫正远视力差异无统计学意义(P>0.05);Tetraflex组患者的裸眼近视力和最佳矫正远视力下近视力与单焦组比较差异有统计学意义(P<0.05)。术后Tetraflex组拟调节力均高于SA60AT组(P<0.05),于术后6mo Tetraflex组拟调节力有所下降,与1,3mo比较差异均有统计学意义(P<0.05),两组间对比敏感度差异无统计学意义。脱镜率及和主观视功能满意度,Tetraflex可调节IOL组均明显优于单焦组,差异有统计学意义(P<0.05)。结论:可调节IOL可提供较好的远近视力,增加拟调节力,有效降低患者术后对老视镜的依赖,改善主观视功能。但其拟调节力仍需要进一步的研究。     

不同多焦点人工晶状体植入术后视觉效果的比较

目的：比较不同多焦点人工晶状体(MIOL)植入治疗白内障术后患者的视觉质量。

方法：选取2016-02/2017-06于本院行白内障超声乳化摘除联合MIOL植入手术的年龄相关性白内障患者78例78眼。根据植入MIOL的不同分为A、B、C组,各26例26眼。A组植入区域折射型MIOL SBL-3,B组植入阶梯渐进衍射型MIOL SN6AD1,C组植入全光学面衍射型MIOL Tecnis ZMB00。比较三组患者术后3mo的视力恢复情况、对比敏感度、离焦曲线、对比度视力以及视觉质量满意度。

结果：三组患者术后不良反应发生情况比较,差异无统计学意义(P>0.05); 三组患者裸眼中视力、裸眼近视力、矫正远视力下的中视力、矫正远视力下的近视力的比较,差异均有统计学意义(P<0.05),且A、B组均显著优于C组(P<0.05)。三组患者术后在明光、明光眩光下4种空间频率(3、6、12、18c/d)以及暗光、暗光眩光下3种空间频率(3、6、12c/d)的对比敏感度比较,差异均有统计学意义(P<0.05),且A组患者均显著优于B、C组患者(P<0.05)。三组患者术后离焦曲线表明A、B组患者在-1.5、-2.0、-2.5D处视力高于C组患者(P<0.05)。三组患者术后对比度为20%、9%的对比度视力比较,差异均有统计学意义(P<0.05),且A组显著优于B、C组患者(P<0.05)。三组患者术后视觉质量满意度比较,差异有统计学意义(P<0.05),且A组显著优于B、C组(P<0.05)。

结论：区域折射型MIOL SBL-3不仅可提供较理想的远、近、中视力,还可提供更佳的对比敏感度及对比度视力,从而提高了患者对视觉质量的满意度。