International Journal of Ophthalmology-IJO is a global ophthalmological scientific publication and a peer-reviewed open access periodical (ISSN 2222-3959 print, ISSN 2227-4898 online). This journal is sponsored by Chinese Medical Association Xi’an Branch and published by the IJO Press. It has been indexed in SCIE, PubMed, PMC, CA, IC, Scopus, EMBASE and DOAJ, and was selected for China's Science and Technology Journal International Influence Enhancement Plan (D-class projects). IJO’s JCR IF in 2024 is 1.8 (Q3), Five-year Impact Factor is 1.8, CiteScore in 2024 is 2.8. IJO was established in 2008, with editorial office in Xi’an, China. It is a monthly publication and accept contributions from all over the world, both basic and clinical research.
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Ling-Yu Zhang, Qing-Jian Li, Qiang Zhou, Yu Zhang, Yan Liu, Zhi-Liang Wang, Pei Zhang
2025,18(9):1613-1618 ,DOI: 10.18240/ijo.2025.09.01
Abstract:
AIM: To determine whether chronic smoking affects fundus blood flow density using optical coherence tomography angiography (OCTA) based on artificial intelligence (AI). METHODS: All participants underwent a comprehensive ophthalmological examination in this study. The subjects were categorized into two groups: control and smoker. Fundus data obtained through the novel OCTA device were compared. RESULTS: Utilizing deep learning denoising techniques removed background noise and smoothed vessel surfaces. OCTA showed a significant decrease in fundus blood flow density after AI-based denoising on the right eyes of 36 smokers (36 males, average age 44.17±9.85y) and age- and sex-matched participants who never smoked. The thickness of the retina in both control and smoker groups failed to show any statistically significant differences. Smoking was associated with decreased blood flow density in the macula and the optic disk. CONCLUSION: Utilizing AI-based denoising to improve the sensitivity of OCTA images can be highly beneficial.
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Chen Xin, Qing Sang, Shen Wu, Rui-Qi Pang, Dan-Ting Lin, Huai-Zhou Wang, Ning Lu, Ning-Li Wang
2025,18(9):1619-1625 ,DOI: 10.18240/ijo.2025.09.02
Abstract:
AIM: To propose a novel glaucoma surgery for rebalancing translaminar pressure difference. METHODS: Three non-human primates with normal eyes and two with laser-induced glaucoma underwent the novel surgical procedure. Cannulation of the subarachnoid space was performed after completion of routine vitrectomy steps. An XEN 45 implant was inserted into the created puncture to communicate between the vitreous body and subarachnoid space. Intraocular pressure (IOP), fundus photography, and spectral-domain optical coherence tomography were assessed at baseline and regular intervals during follow-up. RESULTS: All operated eyes showed IOP reduction in the first postoperative month. Two (2/3) normal eyes and one (1/2) glaucomatous eye maintained lower IOP until 18mo after operation. The XEN 45 implant remained positioned through the lamina cribrosa in all normal eyes but was not detected in two glaucomatous eyes. Complications observed in this study included retinal vascular bleeding in 1/3 normal eyes and XEN implant dislocation in all 2 glaucomatous eyes. CONCLUSION: Subarachnoid space cannulation and mini-shunt implantation may contribute to IOP reduction, possibly by rebalancing translaminar pressure difference and enhancing aqueous humor drainage. The development of a suitable mini-shunt requires further investigation.
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Ya-Jun Gong, Zhi-Lin Zou, Kai-Rui Qiu, Qiang Wang, Xiao-Lai Zhou
2025,18(9):1626-1639 ,DOI: 10.18240/ijo.2025.09.03
Abstract:
AIM: To investigate the role of RNA methylation in retinal pigment epithelial (RPE) cells in age-related macular degeneration (AMD). METHODS: RNA methylation-related gene expression profiles of AMD patient and normal control retinal pigment epithelium were evaluated by single-cell transcriptome from 34 samples (11 from normal donors and 23 from AMD patients). The causal relationship between RNA methylation dysfunction and AMD was analyzed by summary-data-based Mendelian randomization (SMR) using AMD GWAS data and multi-omics quantitative trait loci (QTL), including expression QTLs (eQTLs), protein QTLs (pQTLs), splicing QTLs (sQTLs), and m6A-QTLs (mQTLs). Additionally, machine learning models were applied to validate the causal association between RNA methylation dysfunction and AMD using Bulk RNA sequencing data from 31 normal donors and 37 AMD patients. RESULTS: The single-cell transcriptome data analysis revealed massive dysregulation of RNA methylation-related gene expression in the RPE of AMD patients. SMR revealed causal associations between key RNA methylation regulators (METTL3, NSUN6, and MRM1, etc.) and AMD onset. Machine learning models further validated these findings and demonstrated a high accuracy of AMD risk prediction by using the above-identified RNA methylation-related genes: METTL3, NSUN6, and MRM1. Furthermore, METTL3 and NSUN6 were found to have a protective effect, while MRM1 was associated with an increased risk of AMD. CONCLUSION: The results reveal the implication of dysregulation of RNA methylation-related gene expression in the RPE of AMD patients and further demonstrated a causal association between RNA methylation-related genes (METTL3, NSUN6, and MRM1) and AMD. These findings highlight the importance of RNA methylation in the pathogenesis of AMD and offer potential biomarkers and therapeutic targets for AMD management.
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Chen Li, Yi-Cheng Lu, Ming-Xuan Chen
2025,18(9):1640-1649 ,DOI: 10.18240/ijo.2025.09.04
Abstract:
AIM: To investigate cuproptosis-related molecular and immune infiltration in age-related macular degeneration (AMD) development and establish a predictive model. METHODS: The expression profiles of cuproptosis-related genes and immune signature in AMD based on the microarray dataset GSE29801 were analyzed. A total of 142 AMD samples were used to identify the cuproptosis-related differentially expressed genes (Cu-DEGs), together with the immune cell infiltration. To further refine the list of potential genes for AMD diagnosis, three machine learning techniques were used, and an external dataset were applied for confirming the accuracy of the predictive performance. Reverse transcription polymerase chain reaction (RT-PCR) were also performed to examine the level of mRNA of hub genes. The activated immune responses and Cu-DEGs were assessed between AMD and controls. RESULTS: Six genes, including ATP7A, DBT, VEGFA, UBE2D3, CP, SLC31A1, were screened as cuproptosis-signature in AMD via three machine learning methods. Next, SLC31A1 and VEGFA was selected as hub genes by performance evaluation in an external dataset GSE160011, further analysis showed that SLC31A1 and VEGFA were associated with pathways related to immune signaling and immune function, which were then observed in relation to infiltrating immune cells. Finally, the mRNA expression levels of SLC31A1 and VEGFA were significantly higher in laser induced choroidal neovascularization (CNV) group than in control group detected by RT-PCR. CONCLUSION: In this study, the possible relationship between cuproptosis and AMD is expounded systematically. A predictive model is developed to assess the risk of cuproptosis-related genes and their clinical prognostic value in AMD patients.
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Run-Zi Yang, Ming-Shen Ma, Rui Liu, Ting-Ting Ren, Jing Li, Nan Wang, Liang-Yuan Xu, Qi-Han Guo, Jian-Min Ma
2025,18(9):1650-1657 ,DOI: 10.18240/ijo.2025.09.05
Abstract:
AIM: To examine carcinoma ex pleomorphic adenoma (CXPA) and its development to provide information for its clinical assessment and prognosis. METHODS: The clinical data of 26 patients with pathologically diagnosed CXPA were included for analysis. The patients’ medical histories and data (e.g., gender, age, eye laterality, clinical manifestations, pathologic and immunohistochemical indices, treatments, and prognosis) were recorded. RESULTS: The average age of the 26 patients was 59.6±15.7y. There was no significant difference in the gender distribution. The incidence of CXPA bone destruction was approximately 57.7%, and the incidence of optic nerve involvement and extraocular muscle involvement was approximately 15.4% and 19.2%, respectively. The most common pathological type was adenocarcinoma (34.6%), followed by ductal carcinoma (26.9%). Five patients had recurrence or metastasis (19.2%). The 5-year recurrence-free survival rate was 59.0%. There were no significant differences in survival rates among patients with different pathologic types and stages (P>0.05). Bone destruction, nerve invasion, and peripheral tissue invasion did not significantly affect survival rate (P>0.05). Surgery combined with 125I radiation therapy leads to a better survival prognosis (P<0.05). CONCLUSION: CXPA has a variety of pathologic classifications, with characteristics of bone destruction and peripheral tissue invasion. Surgery combined with 125I endoradiotherapy is a preferable treatment option. However, long-term follow-up and close observation for recurrence or metastasis should be performed.
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Josefina Reñones, Humberto Carreras, Alfonso Antón-López, Ángel García-García, Rafael Melián, Juan Francisco Loro-Ferrer, David P Piñero
2025,18(9):1658-1664 ,DOI: 10.18240/ijo.2025.09.06
Abstract:
AIM: To assess whether the implantation of a posterior chamber phakic intraocular lens produces changes in optical coherence tomography (OCT) measurements of macular thickness (MT) and two parameters that define the structure of the optic nerve, the peripapillary nerve fiber layer (RNFL) and the Bruch’s membrane opening-minimum rim width (BMO-MRW). METHODS: This nonrandomized prospective pre-post study included 86 eyes of 48 patients (age, 20-47y; axial length: 23.10-28.95 mm) scheduled for myopia or myopic astigmatism correction with implantation of the implantable collamer lens (ICL). Eyes with glaucoma or any other ocular disease that could alter OCT results were excluded. RNFL, BMO-MRW and MT were measured preoperatively, and at 1 and 6mo after surgery using spectral-domain OCT. Changes between preoperative and postoperative values were evaluated. RESULTS: There was a significant increase in BMO-MRW at 1mo (mean change: 3.48±15.07 µm, P=0.041). No significant changes were found during the rest of follow-up (1-6mo postop., P=0.623). There was also a significant increase in RNFL thickness at 1mo after surgery (1.45±2.18 µm, P<0.001), but with a significant reduction from 1 to 6mo postoperatively (P=0.002). Regarding MT, it increased significantly at 1mo (2.46±3.76 µm, P<0.001), with a significant decrease afterwards (P=0.048). Measurements of the three parameters at 6mo were slightly superior to preoperative values (P<0.01). CONCLUSION: Minimal changes are induced in BMO-MRW, RNFL and MT after ICL implantation in healthy eyes, confirming the safety of the surgical procedure regarding the structure of the optic nerve head and the macula, and indicating that this phakic intraocular lens seems to have a slight impact on OCT measurements.
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Hui-Ping Yao, Ya-Nuo Wang, Yan-Wei Chen, Sha Gao, Yi-Sheng Zhong, Xi Shen
2025,18(9):1665-1672 ,DOI: 10.18240/ijo.2025.09.07
Abstract:
AIM: To present a case series of rapid-onset neovascular glaucoma (NVG) accompanied by vitreous haemorrhage (VH) following cataract surgery in diabetic patients, and to evaluate the efficacy of pars plana vitrectomy (PPV) combined with Ahmed glaucoma valve (AGV) implantation. METHODS: This is a retrospective, single-center, consecutive case series. All patients underwent 23-gauge PPV with AGV implantation 2–3d after intravitreal ranibizumab injection (IVR). The minimum postoperative follow-up period lasted 12mo. The primary outcome measures included best-corrected visual acuity (BCVA), intraocular pressure (IOP), and topical hypotensive medications. RESULTS: Fifteen diabetic patients (age, 46–81y) with rapid-onset NVG and VH following uncomplicated phacoemulsification were included. The median time to the initial NVG diagnosis following cataract surgery was within 4wk. After PPV combined with AGV implantation, the mean BCVA (logMAR) improved from 1.9 (range: 1.0 to 2.6) preoperatively to 1.2 (range: 0.2 to 2.6) at the final follow-up. Baseline BCVA and the presence of diabetic nephropathy (DN) were significantly associated with the final BCVA in the multiple regression model. The mean postoperative IOP at all follow-up visits was significantly reduced compared to baseline. At the final follow-up, 9 patients required one or two topical ocular hypotensive medications, while the other 6 needed not. Success was achieved in 87%, and the reoperation rate was 20%. The majority of NVG cases (9/15) were primarily attributed to the rapid progression of proliferative diabetic retinopathy. However, a notable subset (6 eyes) was complicated retinal vein occlusion or carotid artery occlusion. CONCLUSION: PPV combined with AGV implantation after adjuvant IVR for rapid-onset NVG with VH following diabetic cataract surgery is one of the safe and effective treatments. Baseline BCVA and preexisting DN may be potential indicators for visual outcomes.
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Iden M. Amiri, Heran W. Gebreyesus, Nathan Grove, Jennifer L. Patnaik, Malik Y. Kahook, Leonard K. Seibold
2025,18(9):1673-1680 ,DOI: 10.18240/ijo.2025.09.08
Abstract:
AIM: To evaluate the one-year clinical outcomes of a novel canaloplasty device used in combination with cataract extraction (CE) in patients with mild to severe open angle glaucoma (OAG). METHODS: This study reviewed patients diagnosed with mild to severe OAG, who underwent canaloplasty with the STREAMLINE® Surgical System combined with CE. The primary outcome was surgical success, defined as achieving ≥20% intraocular pressure (IOP) reduction and/or a reduction of ≥1 glaucoma medication compared to baseline. Secondary outcomes included mean IOP, average number of glaucoma medications, and best-corrected distance visual acuity (BCDVA). Data was collected preoperatively and at multiple postoperative time points up to one year. RESULTS: A total of 68 eyes of 47 patients were included with mean age was 73.1±7.0y and 60% were females. Surgical success at one year was achieved in 68.8% of eyes, with 67.6% success in mild, 80.0% in moderate, and 66.7% in severe OAG cases. IOP was significantly reduced from a baseline of 16.1±0.5 to 14.7±0.4 mm Hg at one year (P=0.0004). The number of medications decreased significantly in all eyes from a baseline of 1.2±0.1 to 0.6±0.1 at one year (P<0.0001). When stratified by glaucoma severity, only the mild group experienced a statistically significant decrease from a baseline of 1.1±0.1 to 0.4±0.1 (P<0.0001). BCDVA improved significantly from baseline to one year. No sight-threatening complications were reported. CONCLUSION: Canaloplasty using the STREAMLINE® surgical system combined with CE effectively reduces IOP at one year in mild to severe OAG with minimal complications. IOP lowering efficacy, reduction in IOP lowering medications, and safety in moderate to severe OAG require further study.
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Jing-Yao Liu, Ju-Ping Liu, Xiao-Rong Li
2025,18(9):1681-1688 ,DOI: 10.18240/ijo.2025.09.09
Abstract:
AIM: To report the 24mo outcomes of vascular endothelial growth factor (VEGF) inhibitors for myopic choroidal neovascularization (mCNV) in routine clinical practice and simultaneously evaluated the real-world safety. METHODS: The patients who received intravitreal injections of VEGF inhibitors of either ranibizumab (0.5 mg) or conbercept (0.5 mg) for mCNV were analyzed from 1 January 2017 to 1 January 2022. The primary outcome variables were mean change in best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes. The secondary outcome variables included IOP changes, the period of mCNV re-treatment, and ocular adverse events. RESULTS: Totally 83 patients aged 56.40±15.36y with axial length 29.67±2.09 mm were included. In visual acuity, the mean logMAR BCVA at baseline was 0.81±0.43. After the initial improvement at 1, 3, and 6mo (P<0.05), from month 12 onwards, no statistical difference compared to baseline was found. The mean CMT from 1mo onwards had a statistically significant decrease compared with baseline CMT (P<0.05). The regression model showed better baseline BCVA and thicker baseline CMT, significantly associated with the final outcomes. In univariate analysis, choosing 3+pro re nata (PRN) as the initial injection treatment regimen was associated with better BCVA at 24mo [hazard ratio (HR)=-0.65, 95%CI: -1.23, -0.07, P=0.048]. However, the difference was not significant in multivariate analysis (HR=-0.59, 95%CI: -1.21, 0.03, P=0.089). Regarding mCNV recurrence, the mean period (P=0.725) and the proportion of mCNV reactivation (P=1.00) were similar between ranibizumab and conbercept. Kaplan-Meier plot also analyzed that the median time of re-injection was not significantly different among gender, drug, and initial injection treatment regimen. No systemic adverse events related to the therapy were observed. CONCLUSION: BCVA gains achieved by the end of our study maintain generally sustained at the 24-mo follow-up. The findings also indicate that ranibizumab and conbercept demonstrate comparable efficacy and safety profiles. Additionally, intravitreal anti-VEGF therapy using 1+PRN regimen, offers certain advantages in both efficacy and cost-effectiveness.
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Yu-Tong Xia, Jia-Yun Ge, Zong-Chan Zhang, Li-Yue Zhang, Ying-Ying Wen, Ying Xie, Ye Shen, Jian-Ping Tong
2025,18(9):1689-1696 ,DOI: 10.18240/ijo.2025.09.10
Abstract:
AIM: To investigate the outcomes and prognosis of macular epiretinal membrane (ERM) after pars plana vitrectomy (PPV) in patients with high myopia (HM), focusing on the optimal timing of surgery and its impact on prognosis. METHODS: The clinical data of 50 eyes from 49 patients diagnosed with ERM, who were highly myopic and underwent PPV were retrospectively analyzed. The patients with ERM were classified into five groups based on the characteristics associated with different levels of myopic traction maculopathy. Group 1: Simple ERM without complex vertical and tangential direction traction on retina on optical coherence tomography (OCT) image; Group 2: ERM with obvious macular foveal schisis, without macular hole (MH); Group 3: ERM with inner lamellar MH, with or without macular foveal schisis; Group 4: ERM with outer lamellar MH, with or without foveal retinal detachment (RD); Group 5: ERM with full-thickness MH. Baseline characteristics, changes in best corrected visual acuity (BCVA) before and after surgery, and anatomical characteristics through spectral domain OCT were compared. RESULTS: The 50 eyes were followed for 6mo, with an average age of 58.66y and an average axial length (AL) of 28.69 mm. Among the five groups, postoperative logMAR BCVA improved (P<0.05). Group 1 had better mean BCVA at baseline (0.59±0.36) and at 6mo postoperatively (0.16±0.22) compared to the other groups, while Group 5 had worse mean BCVA at baseline (1.68±0.45) and at 6mo postoperatively (1.27±0.64). There were no statistically significant differences in sex, age or AL between the groups (P>0.05). OCT showed that Groups 4 and 5 exhibited poorer macular anatomy compared to the other three groups, as evidenced by lower rates of central retinal reattachment (64.3% in Group 4, 86.7% in Group 5) and integrity of the inner segment/outer segment of photoreceptor junction (28.6% in Group 4, 26.7% in Group 5). CONCLUSION: PPV is an effective treatment for ERM in patients with HM. All groups showed postoperative improvement in BCVA compared to preoperative levels, demonstrating the necessity of surgical intervention. Early intervention, particularly before the fourth stage of the disease, may lead to better visual outcomes.
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Zhang-Rong Yang, Chang Li, Dong-Jun Xing, Gao-Xu Wei, Ce-Ce Zhao, Miao Zhou, Xiao-Han Ma, Yi Zhao, Shu Yang, Rong-Guo Yu, Zhi-Qing Li
2025,18(9):1697-1704 ,DOI: 10.18240/ijo.2025.09.11
Abstract:
AIM: To investigate the prevalence and clinical implications of hyperreflective walls (HRW) in foveal cystoid spaces in patients with cystoid macular edema (CME) caused by retinal diseases and noninfectious uveitis (NIU). METHODS: This retrospective cross-sectional study included 443 eyes with CME secondary to diabetic macular edema (DME), retinal vein occlusion (RVO), retinitis pigmentosa (RP), neovascular age-related macular degeneration (nAMD), and NIU. Demographic data, HRW features, and other spectral domain optical coherence tomography (SD-OCT) biomarkers were analyzed. RESULTS: HRW was observed in 40.9% of DME eyes (present, n=77, 38 males, 58.30±12.04y; absent, n=111, 50 males, 55.95±10.56y), 32.5% of RVO eyes (present, n=49, 22 males, 64.53±11.90y; absent, n=102, 42 males, 60.67±11.73y), 31.4% of nAMD eyes (present, n=16, 8 males, 70.13±7.75y; absent, n=35, 13 males, 73.91±9.11y), 57.1% of RP eyes (present, n=12, 4 males, 40.50±12.06y; absent, n=9, 4 males, 44.11±14.32y), and 18.8% of uveitic macular edema (UME) eyes (present, n=6, 3 males, 30.83±16.23y; absent, n=26, 12 males, 43.46±17.58y). HRW was significantly associated with vitreoretinal abnormalities [odds ratio (OR), 2.202; 95% confidence interval (95%CI), 1.342–3.613; P=0.002], hyperreflective foci (OR, 3.33; 95%CI, 1.884–5.883; P<0.001), inner retinal layer disorganization (OR, 1.816; 95%CI, 1.087–3.035; P=0.023), external limiting membrane disruptions (OR, 3.476; 95%CI, 1.839–6.574; P<0.001), and disrupted ellipsoid zone length (OR, 1.001; 95%CI, 1.000–1.002; P=0.04), and a high HRW height in the foveal cystoid spaces (OR, 1.003; 95%CI, 1.001–1.006; P=0.003). CONCLUSION: HRW in foveal cystoid spaces is a common OCT finding in CME and is associated with more severe retinal structural damage and worse visual acuity. HRW may be utilized as a prognostic OCT biomarker for disease severity and treatment response in patients with CME. This study suggests that early detection of HRW and optimization of treatment strategies may improve patient prognosis.
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Muhammad Ikram Ullah, Rubina Dad, Zaira Rehman, Muhammad Shakil, Abdullah Alsrhani, Ayman Ali Mohammed Alameen, Heba Bassiony Ghanem, Emad Manni, Muhammad Umer Khan, Muhammad Atif
2025,18(9):1705-1712 ,DOI: 10.18240/ijo.2025.09.12
Abstract:
AIM: To detect and segregate causative mutations in congenital families with optic nerve hypoplasia (ONH). METHODS: Two unrelated consanguineous Pakistani families with severe ONH, showing features of micropthalmia, nystagmus, corneal opacity, and keratopathy were included. Genetic analysis was carried out by Target Panel Sequencing, and the nucleotide variant was confirmed by Sanger sequencing. In silico analyses were carried out to study the protein order-disorder functions and their effects on messenger ribonucleic acid (mRNA). RESULTS: Target panel sequencing revealed that the afflicted family members carried a novel frameshift mutation (NM_145178.4; c.91del G; p.Gly31Glyfs*55) that ensued in the conservation of an amino acid residue in the bHLH domain of ATOH7 protein. In silico studies predicted that the activity of the ATOH7 gene is probably affected by this mutation, which results in a shortened and non-functional protein. Three-dimensional structural analysis shows that DNA binding may be impacted by amino acid changes from non-polar to positively charged and vice versa (Arg42Pro and Pro18Arg), as well as from positively charged (Arg) to a small polar amino acid (Gly). CONCLUSION: A novel ATOH7 mutation is harmful. This study also emphasizes the potential effects of modified ATOH7 configurations on the stability and functionality of proteins.
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Natalia Christina Angsana, Amelia Devy Indriasari, Indra Tri Mahayana
2025,18(9):1713-1717 ,DOI: 10.18240/ijo.2025.09.13
Abstract:
AIM: To measure abducens nerve palsy patients’ visual angle using real time video-based gaze tracking system. METHODS: This research was a cross-sectional study. The subjects were taken by convenience sampling technique in the Neuro-ophthalmology department at Sardjito General Hospital Yogyakarta, Indonesia, and had met the inclusion and exclusion criteria. The visual angle measurements were performed using an eye tracker with a computer webcam (GENICULA system/Gaze Tracking Artificial Intelligence for Ocular Motor Palsy). The analytical method used was the Mann-Whitney test to compare the visual angle between the abducens nerve palsy group and the healthy eye group. The Wilcoxon test was used to see the significance of differences in visual angle improvement in abducens nerve palsy patients. RESULTS: A total of 39 subjects participated, with a mean age of 46.54±15.67y; 17 were male and 22 were female. The visual angle was 20.88±3.76 in the abducens nerve palsy group (n=39 eyes) and 23.10±2.91 in the normal group (n=39 eyes, P=0.011). The visual angle improvement of abducens nerve palsy before and after cured was statistically significant (P=0.039). CONCLUSION: The real time video-based gaze tracking system is easy to use, efficient, and accurate. A slight decrease in visual angle measurement can be detected using this GENICULA system and therefore it is important for diagnosis slight deviation in abducens nerve palsy.
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Sha-Sha Zhang, Jiao-Jiao Liang, Yun Feng, Xia Hong, Yi-Jia Zhao, Ling Chen, Ping Lin
2025,18(9):1718-1729 ,DOI: 10.18240/ijo.2025.09.14
Abstract:
AIM: To investigate the causal relationship between dietary intake and myopia using Mendelian randomization (MR) analysis. METHODS: Genome-wide association study (GWAS) data from the IEU Open GWAS database were utilized to examine associations between myopia and various dietary factors. MR analysis, incorporating both univariable and multivariable approaches, assessed the impact of food intake on myopia risk through five analytical methods, with inverse variance weighted (IVW) serving as the primary reference. Sensitivity analyses, including heterogeneity assessment, horizontal pleiotropy evaluation, and leave-one-out analysis, were conducted to validate the MR findings. RESULTS: Univariable MR analysis identified a causal link between food intake and myopia. Consumption of breaded fish, canned soup, sweet biscuits, and certain fruits correlated with a lower risk of myopia, whereas intake of low-calorie hot chocolate and cereal was associated with an increased risk. Multivariable MR analysis further confirmed that breaded fish consumption exerted a direct protective effect against myopia, particularly when consumed alongside other dietary components. These findings highlight the intricate interplay between specific dietary factors and myopia development, offering valuable insights for further research. CONCLUSION: MR analysis provides evidence supporting a potential causal relationship between breaded fish intake and myopia, underscoring its relevance in targeted myopia prevention strategies.
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Min Lang, Jie Xuan, Xue Li, Ming-Ming Liu, Jie Xu, Ting Liu
2025,18(9):1730-1736 ,DOI: 10.18240/ijo.2025.09.15
Abstract:
AIM: To assess and rank the efficacy of various non-steroidal anti-inflammatory drugs (NSAIDs) in preventing postoperative macular edema (PME) after cataract surgery. METHODS: A comprehensive search was conducted across PubMed, Embase, Cochrane Library, and Web of Science databases. Randomized controlled trials (RCTs) comparing different NSAIDs and control treatments for the prevention of PME were included. Data from the studies were synthesized using the “gemtc” package in R. Risk of bias was assessed with the Cochrane RoB 2 tool, and heterogeneity was evaluated using the global I2 statistic. Surface under the cumulative ranking curve (SUCRA) values were calculated for each treatment. RESULTS: Of 132 identified records, 9 RCTs met the inclusion criteria. The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME, followed by artificial tear substitute, ketorolac, diclofenac, and bromfenac. The league table comparisons and rankograms corroborated these findings, with nepafenac consistently ranking highest. Heterogeneity analysis yielded high I2 values, indicating substantial variability across studies. CONCLUSION: This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery. Given the substantial heterogeneity observed, further high-quality RCTs are required to confirm these findings and explore the sources of variability. Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.
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Zhe Yang, Jia-Yi Jiang, Xiao-Hui Zhang
2025,18(9):1737-1746 ,DOI: 10.18240/ijo.2025.09.16
Abstract:
AIM: To provide a comprehensive review of the advances in research on diabetes-associated dry eye (DADE), highlighting its pathophysiological mechanisms, risk factors, and demographic characteristics, laying the foundation for further investigation into its pathogenesis and treatment strategies. METHODS: A systemic review of the documents related to DADE had been performed based on the Web of Science database prior to achieving the plain text files of authors, titles, journals, and abstracts which afterwards had been imported into Citespace and VOSviewer software for data cleansing. The visual analysis was implemented from the following aspects: journals’ publications, author and national cooperation, keyword co-occurrence, timeline analysis, and burst detection. RESULTS: The 318 documents in 167 journals had been incorporated with the overall annual citations and annual publications respectively growing significantly since 2014 and 2016. The keyword co-occurrence networks formed 4 clusters, with the representative keywords being dry eye, diabetes mellitus, prevalence, and diabetic retinopathy. Both the timeline map and the burst detection demonstrated that in the exploration of the pathogenesis of DADE, initial research was dedicated to Sjögren’s syndrome, followed by cross-sectional statistical analysis of the pertinent contributing factors of DADE using online databases. Precisely the oxidative stress seemed to surge into the research spotlight presently. The key pathogenic mechanisms of DADE include inflammation, oxidative stress and corneal neuropathy, contributing to the development of dry eye symptoms. CONCLUSION: Age, gender, diabetes duration, and diabetic retinopathy are strongly associated with the development of DADE, but the impact of other systemic factors require further investigation. With high prevalence of dry eye in Asia, valuable resources like the Korea National Health and Nutrition Examination Survey (KNHANES) database offer crucial data for developing risk prediction models for DADE. Building risk prediction models using machine learning algorithms is a promising future research direction, enabling physicians to identify high-risk individuals and implement early interventions.
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Sahilah Ermawati, Winastari Yarhanim Triniputri, Muhana Fawwazy Ilyas, Syahnaz Adilla, Shafira Nur Hanifa, Azka Auliarahman
2025,18(9):1747-1758 ,DOI: 10.18240/ijo.2025.09.17
Abstract:
AIM: To comprehensively investigate the current state of research on the application of neurotrophic factors in glaucoma therapy and identify potential research hotspots. METHODS: On September 30, 2023, a literature search was conducted on Scopus using specific keywords related to neurotrophic factors and glaucoma. Of the 918 articles retrieved, 780 met the inclusion criteria. These articles were subsequently analyzed and visualized using Google Sheets, Biblioshiny 3.1, and VosViewer 1.6.18. RESULTS: A total of 780 studies published between 1989 and 2023 were included, and the global publication count showed an upward trend through 2023 (projected to continue rising by 2030). The United States, China, Japan, Italy, and Australia were the most significant contributors to the publication output. Research in this field had been published in 313 journals, spanning categories such as pharmacology and drug development, ophthalmology, genetics and gene therapy, and neuroscience. A total of 2622 authors had contributed to these studies, with the most prolific author publishing 14 articles. The focus of research in this field had evolved sequentially from “glutamate” to “CNTF” and “GDNF”, and finally to “optic nerve injury”. Co-occurrence analysis identified five clusters: glaucoma and ocular health, neuroinflammation in ophthalmology, neuroprotection in ophthalmology, ocular drug delivery, and stem cell therapy. Several areas in this field require further exploration, including the neurophysiological mechanisms underlying glaucoma, ocular drug delivery systems, and the clinical value of specific neurotrophic factors. CONCLUSION: This study systematically reviews global research trends on neurotrophic factors in glaucoma therapy, clarifying the current research status and future directions.
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Meng-Sha Sun, Hong-Ping Cui, Jian-Cen Tang
2025,18(9):1759-1769 ,DOI: 10.18240/ijo.2025.09.18
Abstract:
AIM: To analyse the research status and explore global trends in retinal vein occlusion (RVO) studies. METHODS: Publications related to RVO from 2004 to 2023 were extracted from the Web of Science Core Collection (WoSCC). Variables including the number of publications, as well as countries, organizations, authors, journals, references and keywords were analysed using Bibliometrix-BilioShiny. Data visualization was performed using VOSviewer and CiteSpace. RESULTS: A total of 4848 publications were retrieved, and generally, the number of publications showed an overall increasing trend with slight fluctuations over the past 20y. The country with the most publications was the United States. The journal with the most publications was Retina, and the most cited journal was Ophthalmology. The most prolific organization was the University of California, Los Angeles. The most productive author was Noma H, and the most cited author was Campochiaro PA. The top co-cited references mainly focused on the prevalence of RVO and the therapies used in clinical trials. According to the co-occurrence analysis, the keywords formed 3 clusters: 1) risk factors and pathogenesis of RVO, 2) treatments of RVO, and 3) imaging diagnosis of RVO. Anti-vascular endothelial growth factor (VEGF) treatments and artificial intelligence have recently become popular research topics. CONCLUSION: Bibliometric analysis of the research status and trends of RVO could provide researchers and clinicians with valuable insights for further collaboration, future research directions, and clinical practice.
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Xiao-Hong Liu, Xi Shen, Yi-Sheng Zhong
2025,18(9):1770-1776 ,DOI: 10.18240/ijo.2025.09.19
Abstract:
The phenotypes of the adenine-to-guanine transition at position 3243 of mitochondrial DNA (m.3243A>G) are highly variable, with different symptoms observed in different patients. These include mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS); maternally inherited diabetes and deafness syndrome (MIDD); other syndromic conditions; or non-syndromic mitochondrial disorders. Renal involvement associated with this mutation generally manifests as subnephrotic proteinuria, progressive deterioration of kidney function, and increased morbidity. The retinopathies linked to the m.3243A>G mutation have heterogeneous presentations, characterized by variable degrees of retinal pigment epithelium (RPE) atrophy and hyperpigmentation at the posterior pole. As a severe phenotype of the m.3243A>G mutation, MELAS combined with focal and segmental glomerulosclerosis (FSGS) is rare. We herein firstly reported in detail the ophthalmic manifestations of a patient with this condition. Additionally, we reviewed the literature on fundus, ophthalmic electrophysiology, and optical coherence tomography (OCT) findings related to the m.3243A>G mutation.
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Zhen-Yu Liu, Hang Zhang, Xiu-Li Sun
2025,18(9):1777-1789 ,DOI: 10.18240/ijo.2025.09.20
Abstract:
Multiple evanescent white dot syndrome (MEWDS) is an inflammatory fundus disease primarily affecting the outer retina. It is characterized by transient yellow-white dots on the outer retina. Although the exact pathogenesis remains unclear, the progress in multimodal imaging (MMI) has enhanced our understanding of MEWDS. Most cases of MEWDS are idiopathic, lacking a definite cause, and can spontaneously recover; these are what we term classic MEWDS. Consequently, MEWDS is often referred to as the “common cold of the retina”. Simultaneously, patients with other disorders may present with varying degrees of manifestations similar to MEWDS. The resemblance in clinical or imaging findings can lead to misdiagnosis and inappropriate treatment. These MEWDS - like presentations are actually caused by other systemic or ocular disorders with diverse mechanisms. Thus, they differ from classic MEWDS in certain aspects. Using the keywords “MEWDS-like” and “Secondary MEWDS”, we searched for all relevant studies published in the PubMed database from January 2021 to January 2024. Subsequently, we retrospectively summarized the clinical and imaging characteristics of MEWDS, along with the manifestations in other diseases that resembled those of MEWDS, and compared classic MEWDS with these similar presentations. Based on our review, we classified such similar presentations under other conditions into two categories and summarized their features for differential diagnosis. We recommend paying close attention to patients suspected of having MEWDS, as there may be more serious systemic or ocular disorders that require prompt treatment.
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Ji-Fa Kuang, Jing-Hui Wang, Ming-Bing Zeng, Fei-Lan Chen, Wen-Bin Huang
2025,18(9):1790-1796 ,DOI: 10.18240/ijo.2025.09.21
Abstract:
ChatGPT technology based on large language models (LLM) shows great potential in improving the quality of medical care, assisting clinical decision making and optimizing patient communication. The role of ChatGPT in ophthalmology is still in its infancy. This review aims to explore the application prospect of ChatGPT in ophthalmology. Relevant literature was reviewed and analyzed, and the application prospects of LLM represented by ChatGPT in ophthalmology were summarized, including clinical assisted diagnosis, patient education and communication, history collection and text writing, clinical research, and medical education, etc. At the same time, the challenges and solutions faced by ChatGPT in ophthalmology were pointed out. Its safety, efficacy and ethics remain controversial in practical applications. Therefore, it is necessary to strengthen the supervision and research on its application to ensure safety and effectiveness. In the future, with the development of technology, ChatGPT is expected to play a greater role in ophthalmology and enhance the medical experience.
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Wilson X. Wang, Kishan G. Patel, Henok Getahun, Srishti Ramamurthy, Howard Chen, Raja Narayanan, Rajendra S. Apte
2025,18(9):1797-1802 ,DOI: 10.18240/ijo.2025.09.22
Abstract:
AIM: To evaluate visual outcomes of pars plana vitrectomy (PPV) combined with tissue plasminogen activator (tPA)-induced clot lysis and pneumatic displacement for submacular hemorrhage (SMH) in a cohort of closed-globe trauma patients. METHODS: A retrospective, multicenter interventional case series involving 7 eyes of 7 patients who underwent PPV with subretinal tPA administration for SMH secondary to closed-globe injury were conducted. The primary outcome measure was the change in Snellen visual acuity. RESULTS: The mean age of patients was 32y (range: 21-51y), with a mean follow-up duration of 4.6mo (range: 1.1-14.9mo). The average best-corrected visual acuity (BCVA) was 20/1020 at baseline and 20/114 at the final visit, respectively (P=0.025). Preoperative BCVA was not a significant predictor of final BCVA (r=0.102, P=0.827). Final BCVA did not differ significantly between patients who underwent PPV within 14d of symptom onset and those who underwent surgery after 14d (P=0.57). All eyes received SF6 or C3F8 gas tamponade. CONCLUSION: Surgical intervention involving tPA-mediated clot lysis and pneumatic displacement may yield visual benefits in trauma-induced SMH without underlying retinal vascular disease; however, larger prospective studies are warranted to confirm these findings.
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Ali Kasiri, Mostafa Feghhi, Ali Ansari, Rozhin Kasiri, Mohammad Sadegh Mirdehghan, Abbas Mohammadi, Mohammad Armin Kasiri
2025,18(9):1809-1811 ,DOI: 10.18240/ijo.2025.09.25
Abstract:
Volume 18,2025 Issue 9
Intelligent Ophthalmology
Basic Research
Clinical Research
Mendelian Randomization
Meta-Analysis
Bibliometric Research
Review Article
Brief Report
Letter to the Editor
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Algorithm of automatic identification of diabetic retinopathy foci based on ultra-widefield scanning laser ophthalmoscopy
Jie Wang, Su-Zhen Wang, Xiao-Lin Qin, Meng Chen, Heng-Ming Zhang, Xin Liu, Meng-Jun Xiang, Jian-Bin Hu, Hai-Yu Huang, Chang-Jun Lan
Abstract:
● AIM: To propose an algorithm for automatic detection of diabetic retinopathy (DR) lesions based on ultra-widefield scanning laser ophthalmoscopy (SLO). ● METHODS: The algorithm utilized the FasterRCNN (Faster Regions with CNN features)+ResNet50 (Residua Network 50)+FPN (Feature Pyramid Networks) method for detecting hemorrhagic spots, cotton wool spots, exudates, and microaneurysms in DR ultra-widefield SLO. Subimage segmentation combined with a deeper residual network FasterRCNN+ResNet50 was employed for feature extraction to enhance intelligent learning rate. Feature fusion was carried out by the feature pyramid network FPN, which significantly improved lesion detection rates in SLO fundus images. ● RESULTS: By analyzing 1076 ultra-widefield SLO images provided by our hospital, with a resolution of 2600×2048 dpi, the accuracy rates for hemorrhagic spots, cotton wool spots, exudates, and microaneurysms were found to be 87.23%, 83.57%, 86.75%, and 54.94%, respectively. ● CONCLUSION: The proposed algorithm demonstrates intelligent detection of DR lesions in ultra-widefield SLO, providing significant advantages over traditional fundus color imaging intelligent diagnosis algorithms.
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Abstract:
AIM: To explore the correlation between several blood cell-associated inflammatory indices including mean platelet volume (MPV), platelet distribution width (PDW), neutrophil to lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), and the presence and severity of diabetic retinopathy (DR). METHODS: We searched for eligible studies from PubMed, EMBASE, Web of Science and CNKI up to December 13, 2017. Standardized mean difference (SMD) calculated with confidence interval (CI) of 95% was used to estimate the values of those indices. RESULTS: A total of 31 studies were included in the present Meta-analysis. As compared with type 2 diabetes mellitus (T2DM) patients without DR, the values of MPV, PDW, NLR, and PLR were higher in patients with DR (SMD=0.67; 95%CI: 0.36 to 0.98; SMD=0.51; 95%CI: 0.27 to 0.75; SMD=0.77; 95%CI: 0.49 to 1.05 and SMD=1.18; 95%CI: 0.07 to 2.28). Additionally, it was also observed that MPV was closely correlated with the severity of DR. CONCLUSION: MPV, PDW, NLR, and PLR could be recommended as diagnostic biomarkers for DR, and MPV could be applied to assess the severity of DR.
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Arshad Ali Lodhi, Sameen Afzal Junejo, Mahtab Alam Khanzada, Imran Akram Sahaf, Zahid Kamal Siddique
Abstract:
AIM: To evaluate the surgical outcome of congenital upper eyelid coloboma repair. · METHODS: All patients underwent complete ophthalmic and general examination before going to surgery, and then examination under anesthesia was performed to assess the site and size of eyelid defect, conjunctival involvement. The status of cornea and ocular motility with forced duction test was also being noted. The surgical procedure was performed according to the size of defect. · RESULTS: Out of 21 cases of congenital upper eyelid coloboma, 18 occurred in isolation with upper eyelid medial defect, 13 were bilateral and 5 were unilateral. Others were associated with Goldenhar syndrome and CHARGE syndrome with bilateral upper lid medial defects. All patients were presented for surgical corrections during age of 2.5-4.0 years except one that presented at 25 years of age. Cosmetically surgical results were acceptable, except one that was already presented with opaque corneal. · CONCLUSION: In this study, overall surgical results were satisfactory except one that was presented late with compromised cornea.
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Veronica E. Giordano, Sergio E. Hernandez-Da Mota, Tania N. Adabache-Guel, Armando Castillejos-Chevez, Sonia Corredor-Casas, Samantha M. Salinas-Longoria, Rafael Romero-Vera, Juan M. Jimenez-Sierra, Jose L. Guerrero-Naranjo, Virgilio Morales-Canton
Abstract:
AIM: To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection. METHODS: Eighteen New Zealand white rabbits were divided into three treatment groups (groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group. The right eye was injected with the drug and the left eye received intravitreal injection of 5% dextrose water and served as control eye. The doses delivered to each group were 0.1 mg/0.1 mL, 1 mg/0.1 mL and 10 mg/0.1 mL. Simultaneous, bilateral, dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection (baseline) and after 7, 14, 21 and 28d, followed by enucleation for histological examination. RESULTS: Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3 (Kruskall-Wallis test, P=0.000). By day 7, no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3, consistent with severe damage due to retinal toxicity. Light microscopy revealed no significant histopathological changes in the group 1, while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases. CONCLUSION: Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with 1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.
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Anteneh Amsalu, Kindie Desta, Demiss Nigussie, Demoze Delelegne
Abstract:
AIM: To assess the pattern of ocular manifestation and associated factors among human immunodeficiency virus (HIV) /acquired immunodeficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART) at Hawassa University Referral Hospital, Southern Ethiopia. METHODS: A cross sectional study was conducted from January 2014 to April 2015. After obtaining informed written consent, 240 adult HIV/AIDS patients on HAART were randomly selected regardless of their ophthalmic symptoms, WHO status or CD4 count. Data were collected using structured questionnaires and ophthalmologic clinical examination. Data were entered and analyzed using SPSS version 20.0 software. RESULTS: The mean duration of HAART was 62.5mo. The prevalence of HIV related ocular manifestation was 14.2%. Seborrheic blepharitis (5%) was the most common ocular manifestation, followed by squamoid conjunctival growth (3.8%). The rate of ocular manifestation was significantly higher among study participants who had CD4+ count <200 cells/μL (AOR=3.83; 95%CI: 1.315-11.153), low duration of HAART (AOR=3.0; 95%CI: 1.305-6.891) and who had primary school education [odds ratio (OR) =2.8; 95%CI: 1.105-7.099]. Prevalence of visual impairment and blindness was 10.9% and 5.8%, respectively. CONCLUSION: HAART may be the reason for the decline in the prevalence of ocular manifestation in HIV/AIDS patients in the study area. Ophthalmologic screening of HIV/AIDS patients, especially those with CD4 counts of <200/μL cells and in the first five years of HAART follow-up is recommended to reduce visual impairment and/or blindness.
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Zhi-Chun Zhao, Ying Zhou, Gang Tan, Juan Li
Abstract:
In recent years, people have become increasingly attentive to light pollution influences on their eyes. In the visible spectrum, short-wave blue light with wavelength between 415 nm and 455 nm is closely related to eye light damage. This high energy blue light passes through the cornea and lens to the retina causing diseases such as dry eye, cataract, age-related macular degeneration, even stimulating the brain, inhibiting melatonin secretion, and enhancing adrenocortical hormone production, which will destroy the hormonal balance and directly affect sleep quality. Therefore, the effect of Blu-rays on ocular is becoming an important concern for the future. We describe blue light’s effects on eye tissues, summarize the research on eye injury and its physical prevention and medical treatment.
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Ji Jin, Lei Chen, Gao-Qin Liu, Pei-Rong Lu
Abstract:
AIM: To analyze the retinal proteomes with and without conbercept treatments in mice with oxygen-induced retinopathy (OIR) and identify proteins involved in the molecular mechanisms mediated by conbercept. METHODS: OIR was induced in fifty-six C57BL/6J mouse pups and randomly divided into four groups. Group 1: Normal17 (n=7), mice without OIR and treated with normal air. Group 2: OIR12/EXP1 (n=14), mice received 75% oxygen from postnatal day (P) 7 to 12. Group 3: OIR17/Control (n=14), mice received 75% oxygen from P7 to P12 and then normal air to P17. Group 4: Lang17/EXP2 (n=21), mice received 75% oxygen from P7 to P12 with intravitreal injection of 1 μL conbercept at the concentration of 10 mg/mL at P12, and then normal air from P12 to P17. Liquid Chromatography-Mass Spectrometry (LC-MS)/MS data were reviewed to find proteins that were up-regulated after the conbercept treatment. Gene ontology (GO) analysis was performed of conbercept-mediated changes in proteins involved in single-organism processes, biological regulation, cellular processes, immune responses, metabolic processes, locomotion and multiple-organism processes. RESULTS: Conbercept induced a reversal of hypoxia-inducible factor 1 signaling pathway as revealed by the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis and also induced down-regulation of proteins involved in blood coagulation and fibrin clot formation as demonstrated by the Database for Annotation, Visualization and Integrated Discovery (DAVID) and the stimulation of interferon genes studies. These appear to be risk factors of retinal fibrosis. Additional conbercept-specific fibrosis risk factors were also identified and may serve as therapeutic targets for fibrosis. CONCLUSION: Our studies reveal that many novel proteins are differentially regulated by conbercept. The new insights may warrant a valuable resource for conbercept treatment.
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Xi-Teng Chen, Hui Huang, Yan-Hua Chen, Li-Jie Dong, Xiao-Rong Li, Xiao-Min Zhang
Abstract:
AIM:To identify the genetic defects in a Chinese family with achromatopsia.METHODS:A 2.5-year-old boy, who displayed nystagmus, photophobia, and hyperopia since early infancy, was clinically evaluated. To further confirm and localize the causative mutations in this family, targeted region capture and next-generation sequencing of candidate genes, such as CNGA3, CNGB3, GNAT2, PDE6C, and PDE6H were performed using a custom-made capture array.RESULTS:Slit-lamp examination showed no specific findings in the anterior segments. The optic discs and maculae were normal on fundoscopy. The unaffected family members reported no ocular complaints. Clinical signs and symptoms were consistent with a clinical impression of autosomal recessive achromatopsia. The results of sequence analysis revealed two novel missense mutations in CNGA3, c.633T>A (p.D211E) and c.1006G>T (p.V336F), with an autosomal recessive mode of inheritance.CONCLUSION: Genetic analysis of a Chinese family confirmed the clinical diagnosis of achromatopsia. Two novel mutations were identified in CNGA3, which extended the mutation spectrum of this disorder.
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Abstract:
Simulation can be defined as malingering, or sometimes functional visual loss (FVL). It manifests as either simulating an ophthalmic disease (positive simulation), or denial of ophthalmic disease (negative simulation). Conscious behavior and compensation or indemnity claims are prominent features of simulation. Since some authors suggest that this is a manifestation of underlying psychopathology, even conversion is included in this context. In today’s world, every ophthalmologist can face with simulation of ophthalmic disease or disorder. In case of simulation suspect, the physician’s responsibility is to prove the simulation considering the disease/disorder first, and simulation as an exclusion. In simulation examinations, the physician should be firm and smart to select appropriate test(s) to convince not only the subject, but also the judge in case of indemnity or compensation trials. Almost all ophthalmic sensory and motor functions including visual acuity, visual field, color vision and night vision can be the subject of simulation. Examiner must be skillful in selecting the most appropriate test. Apart from those in the literature, we included all kinds of simulation in ophthalmology. In addition, simulation examination techniques, such as, use of optical coherence tomography, frequency doubling perimetry (FDP), and modified polarization tests were also included. In this review, we made a thorough literature search, and added our experiences to give the readers up-to-date information on malingering or simulation in ophthalmology.
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Ping-Ting Zhao, Ling-Jun Zhang, Hui Shao, Ling-Ling Bai, Bo Yu, Chang Su, Li-Jie Dong, Xun Liu, Xiao-Rong Li, Xiao-Min Zhang
Abstract:
AIM: To test the therapeutic effects of delayed treatment of mesenchymal stem cells (MSCs) in recurrent experimental autoimmune uveitis (rEAU). METHODS: The efficacy of different regimens of MSC administration in rEAU were tested by evaluation of clinical and pathological intraocular inflammation, as well as retinal structural and functional integrity using optical coherence tomography (OCT) and electroretinogram (ERG). The retinal sections were also immunostained with antibodies to glial fibrillary acidic protein (GFAP) and rhodopsin (RHO). RESULTS: Delayed treatment of MSCs effectively alleviated the severity of intraocular inflammation with relative intact of outer retinal structure and function. Moreover, double therapies with longer interval led to an even better clinical evaluation, as well as a trend of decrease in relapse and amelioration of retinal function. MSC therapies also effectively reduced GFAP expression and increased RHO expression in the retina. CONCLUSION: MSC administration can effectively treat developed diseases of rEAU, and multiple therapies can provide additional therapeutic benefits.
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Li-Fei Yuan, Guang-Da Li, Xin-Jun Ren, Hong Nian, Xiao-Rong Li, Xiao-Min Zhang
Abstract:
AIM:To determine the effects of rapamycin on experimental autoimmune uveoretinitis (EAU) and investigate of role of rapamycin on T cell subsets in the disease. METHODS:EAU was induced in rats using peptides 1169 to 1191 of the interphotoreceptor binding protein (IRBP). Rapamycin (0.2 mg/kg/d) was administrated by intraperitoneal injection for a consecutive 7d after immunization. Th1/Th2/Th17 cytokines, TGF-β1, and IL-6 produced by lymphocyteswere measured by ELISA, while Th17 cells and CD4+CD25+ regulatory T cells (Tregs) from rat spleen were detected by flow cytometry. RESULTS: Intraperitoneal treatment immediately after immunization dramatically ameliorated the clinical course of EAU. Clinical responses were associated with reduced retinal inflammatory cell infiltration and tissue destruction. Rapamycin induced suppression of Th1/Th2/Th17 cytokines, including IFN-γ, IL-2, IL-17, IL-4, and IL-10 release from T lymphocytes of EAU rats, in vitro. Rapamycin also significantly increased TGF-β1 production but had no effect on IL-6 productionof T lymphocytes from EAU rats in vitro. Furthermore, rapamycin decreased the ratio of Th17 cells/CD4+T cells and upregulated Tregs in EAU, as detected by flow cytometry. CONCLUSION: Rapamycin effectively interferes with T cell mediated autoimmune uveitis by inhibiting antigen-specific T cell functions and enhancing Tregs in EAU. Rapamycin is a promising new alternative as an adjunct corticosteroid-sparing agent for treating uveitis.
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Abstract:
AIM: To report various ocular lesions caused by accidental instillation of superglue.METHODS: Three cases of ocular injuries are described in children aged 6 years, 3 years and 8 months, following accidental instillation of superglue in the eye.RESULTS: In the first case there was sticking of eyelashes in the medial 1/3 of eyelids in both eyes. In the second case sticking of eye lashes was present in the lateral 1/3 of eyelids in the left eye. In the third case, superglue was present on the right cheek, above the right ear and sticking of eyelids in medial 1/3 in right eye. The eyelids were separated by pulling the lid margins with fingers in the first case and later on superglue was removed by trimming the eyelashes; and by direct trimming the eyelashes in second and third cases. There was no injury to other structures of anterior segment in the first two cases. However, removal of the superglue on the cornea resulted in corneal abrasion in the third case which healed with medical treatment and patching of the right eye.CONCLUSION: Accidental instillation of superglue is possible because of the appearance of the tube like eye ointment tube. Immediate medical aid will prevent ocular morbidity.
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Yang-Qing Huang, He Huang, Rong-Zhi Huang
Abstract:
AIM:To introduce a new near-vision chart for children aged 3-5 years old and its clinical applications.METHODS:The new near-vision chart which combined the Bailey-Lovie layout with a newly devised set of symmetry symbols was designed based on Weber-Fechner law. It consists of 15 rows of symmetry symbols, corresponding to a visual acuity range from 1.3 to 0.1 logMAR. The optotypes were red against a white background and were specially shaped four basic geometric symbols:circle, square, triangle，and cross, which matched the preschool children''s cognitive level. A regular geometric progression of the optotype sizes and distribution was employed to arrange in 15 lines. The progression rate of the optotype size between two lines was 1.2589 and two smaller groups of optotypes ranging from 0.7 to -0.1 logMAR were included for repetitive testing. A near visual acuity was recorded in logMAR or decimal, and the testing distance was 25 cm.RESULTS:This new near-vision chart with pediatric acuity test optotypes which consists of 4 different symbols (triangle, square, cross, and circle) met the national and international eye chart design guidelines. When performing the near visual acuity assessment in preschoolers (3-5 years old). It overcame an inability to recognize the letters of the alphabet and difficulties in designating the direction of black abstract symbols such as the tumbling ''E'' or Landolt ''C'', which the subjects were prone to lose interest in. Near vision may be recorded in different notations:decimal acuity and logMAR. These two notations can be easily converted each other in the new near-vision chart. The measurements of this new chart not only showed a significant correlation and a good consistency with the Chinese national standard logarithmic near-vision chart (r=0.932, P<0.01), but also indicated good test-retest reliability (89% of retest scores were within 0.1 logMAR units of the initial test score) and a high response rate.CONCLUSION:The results of this study support the validity and reliability of near visual acuity measurements using the new near-vision chart in children aged 3-5y over a wide range of visual acuities, and the new eye chart was especially suitable for the detection of amblyopia risk factors and low vision examination in children (3-5y of age). It can be applied in routine clinical practice.
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Ali Ihsan Incesu, Güng?r Sobac?
Abstract:
Simulation can be defined as malingering, or sometimes functional visual loss (FVL). It manifests as either simulating an ophthalmic disease (positive simulation), or denial of ophthalmic disease (negative simulation). Conscious behavior and compensation or indemnity claims are prominent features of simulation. Since some authors suggest that this is a manifestation of underlying psychopathology, even conversion is included in this context. In today's world, every ophthalmologist can face with simulation of ophthalmic disease or disorder. In case of simulation suspect, the physician's responsibility is to prove the simulation considering the disease/disorder first, and simulation as an exclusion. In simulation examinations, the physician should be firm and smart to select appropriate test(s) to convince not only the subject, but also the judge in case of indemnity or compensation trials. Almost all ophthalmic sensory and motor functions including visual acuity, visual field, color vision and night vision can be the subject of simulation. Examiner must be skillful in selecting the most appropriate test. Apart from those in the literature, we included all kinds of simulation in ophthalmology. In addition, simulation examination techniques, such as, use of OCT (optical coherence tomography), frequency doubling perimetry (FDP), and modified polarization tests were also included. In this review, we made a thorough literature search, and added our experiences to give the readers up-to-date information on malingering or simulation in ophthalmology.
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Blake F. Webb, Jadon R. Webb, Mary C. Schroeder, Carol S. North
Abstract:
AIM: To estimate the prevalence and risk factors for vitreous floaters in the general population.METHODS: An electronic survey was administered through a smartphone app asking various demographic and health questions, including whether users experience floaters in their field of vision. Multivariate logistic regression analysis was used to determine risk factors.RESULTS:A total of 603 individuals completed the survey, with 76% reporting that they see floaters, and 33% reporting that floaters caused noticeable impairment in vision. Myopes were 3.5 times more likely (P=0.0004), and hyperopes 4.4 times more likely (P=0.0069) to report moderate to severe floaters compared to those with normal vision. Floater prevalence was not significantly affected by respondent age, race, gender, and eye color.CONCLUSION:Vitreous floaters were found to be a very common phenomenon in this non-clinical general population sample, and more likely to be impairing in myopes and hyperopes.
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Bora Yüksel, Sultan Kaya ünsal, Sevgi Onat
Abstract:
AIM: To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft. METHODS: A prospective randomised clinical trial was carried out in 58 eyes of 58 patients operated for primary nasal pterygium. Autologous conjunctival graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision. In 29 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive (Beriplast P) and in 29 eyes with 8-0 Virgin silk sutures. The Mann-Whitney U test was used for statistical analysis. Postoperative patient discomfort (pain, stinging, watering) and biomicroscopic findings (hyperemia, edema) were graded. Patients were followed up at least for six months. RESULTS: Subconjunctival hemorrhage occured under the graft in one patient in group 1. In seven cases of group 2, sutures were removed at the 15th day because of granulomatous tissue reaction. Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in one case of group 1, and 2 cases of group 2. Average surgery cost was higher (P<0.05) and surgery time was shorter (P<0.05) in fibrin group. CONCLUSION: Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.
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Abstract:
Photobiomodulation (PBM), also known as low level laser therapy, has recently risen to the attention of the ophthalmology community as a promising new approach to treat a variety of retinal conditions including age-related macular degeneration, retinopathy of prematurity, diabetic retinopathy, Leber’s hereditary optic neuropathy, amblyopia, methanol-induced retinal damage, and possibly others. This review evaluates the existing research pertaining to PBM applications in the retina, with a focus on the mechanisms of action and clinical outcomes. All available literature until April 2015 was reviewed using PubMed and the following keywords: “photobiomodulation AND retina”, “low level light therapy AND retina”, “low level laser therapy AND retina”, and “FR/NIR therapy AND retina”. In addition, the relevant references listed within the papers identified through PubMed were incorporated. The literature supports the conclusion that the low-cost and non-invasive nature of PBM, coupled with the first promising clinical reports and the numerous preclinical-studies in animal models, make PBM well-poised to become an important player in the treatment of a wide range of retinal disorders. Nevertheless, large-scale clinical trials will be necessary to establish the PBM therapeutic ranges for the various retinal diseases, as well as to gain a deeper understanding of its mechanisms of action.
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Wen-Bin Huang, Qian Fan, Xiu-Lan Zhang
Abstract:
Glaucoma is one of the leading causes of visual impairment and blindness. Improved knowledge of the pathogenesis of this disease has allowed the exploration of new therapeutic methods. In general, elevated intraocular pressure (IOP), oxidative stress, and vascular insufficiency are accepted as the major risk factors for the progression of glaucoma. Many natural compounds have been found beneficial for glaucoma. Nutritional therapies are now emerging as potentially effective in glaucomatous therapy. One nutritional supplement with potential therapeutic value is cod liver oil, a dietary supplement that contains vitamin A and omega-3 polyunsaturated fatty acids (PUFAs). Vitamin A is important for preserving normal vision and it is a well-known antioxidant that prevents the oxidative damage that contributes to the etiology and progression of glaucoma. Vitamin A is also a crucial factor for maintaining the integrity of conjunctival and corneal ocular surfaces, and preventing the impairment of ocular epithelium caused by topical antiglaucomatous drugs. Omega-3 fatty acids are beneficial for glaucoma patients as they decrease IOP, increase ocular blood flow, and improve optic neuroprotective function. In this article, we propose that cod liver oil, as a combination of vitamin A and omega-3 fatty acids, should be beneficial for the treatment of glaucoma. However, further studies are needed to explore the relationship between cod liver oil and glaucoma.
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Jun Yi, Jun Yun, Zhi-Kui Li, Chang-Tai Xu, Bo-Rong Pan
Abstract:
· Congenital cataract is a crystallin severe blinding disease and genetic factors in disease development are important. Crystallin growth is under a combination of genes and their products in time and space to complete the coordination role of the guidance. Congenital cataract-related genes, included crystallin protein gene (CRYAA, CRYAB, CRYBA1/A3, CRYBA4, CRYBB1, CRYBB2, CRYBB3, CRYGC, CRYGD, CRYGS), gap junction channel protein gene (GJA1, GJA3, GJA8), membrane protein gene (GJA3, GJA8, MIP, LIM2), cytoskeletal protein gene (BF-SP2), transcription factor genes (HSF4, MAF, PITX3, PAX6), ferritin light chain gene (FTL), fibroblast growth factor (FGF) and so on. Currently, there are about 39 genetic loci isolated to which primary cataracts have been mapped, although the number is constantly increasing and depends to some extent on definition. We summarized the recent advances on epidemiology and genetic locations of congenital cataract in this review.
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Juan-Juan Li, Yun-Peng Li, Zhu-Lin Hu
Abstract:
We describe the successful treatment in a patient with bilateral congenital aniridia and cataract by insertion of capsular tension rings and IOL.
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Abstract:
AIM: To compare the efficacy for preventing exposure keratopathy of three forms of eye care (artificial tear, moist chamber and polyethylene covers) for intensive care patients. METHODS: Eighty-four patients in Intensive Care Unit (ICU) were randomized to three treatment groups, including artificial tears group, moist chambers group and polyethylene film group. Patients of artificial tear group received two drops of carboxymethylcellulose drops to each eye every 2 hours. The moist chambers and the polyethylene were changed every 12 hours or as needed if they became unclean or torn. The corneal fluorescein stains were performed daily. RESULTS: No of 28 patients (0%) in the polyethylene group and one of the 27 patients (3.70%) in the moist chamber group had exposure keratopathy, compared to 8 of the 29 patients (27.59%) in the artificial tear group. There were statistical significance between the artificial tear group and the moist chamber group (P=0.02), and the artificial tear group and the polyethylene group (P =0.003). The time on eye care every day of the artificial tear group, the moist chamber group and the polyethylene group was 26.69±2.39 minutes, 35.33±2.63 minutes and 7.48±0.87 minutes, respectively. The eye care of the polyethylene group were statistically more time-save than that of the artificial tear group (P<0.001) and the moist chamber group (P<0.001). CONCLUSION: Polyethylene covers are more effective and more time-saving in reducing the incidence of corneal damage in intensive care patients
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