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Objective To investigate the effect of acupuncture on the morphology of the dry eye rabbit's cornea and the nuclear factor κB(NF-κB)signaling pathway of the corneal tissue to analyze the mechanism of acupuncture on dry eyes.Methods Twenty-four healthy New Zealand rabbits,without restriction on sex,were randomly divided into four groups,including a blank group,a model group,an acupuncture group,and a sham acupuncture group,with 6 in each group.Rabbits in the blank group were not treated;rabbits in the other three groups were treated with scopolamine hydro-bromide 2.0 mg·kg-1 by subcutaneous injection at 8:00,11:00,14:00 and 18:00 each day for 35 consecutive days un-til the end of the experiment.Rabbits in the sham acupuncture group were treated with sham acupuncture on the 22nd day after successful modeling by quickly pricking acupoints(Jingming BL1,Cuanzhu BL2,Sizhukong SJ23,Taiyang EX-HN5 and Tongziliao GB1)with a blunt acupuncture needle,once a day,for a total of 14 days.Rabbits in the acupuncture group were treated with acupuncture at the same acupoints as the sham acupuncture group after successful modeling.The corneal fluorescence staining was conducted on Days 0,21,28 and 35 after modeling.On Day 35,corneal confocal microscope ex-aminations were conducted.Then,the rabbits were sacrificed,the corneal morphological changes were observed by light microscope and transmission electron microscope,and the expression of corneal NF-κB protein was detected by Western blot.Results Compared with the model group,the score of rabbit corneal fluorescein staining in the acupuncture group and blank group decreased on the 28th and 35th days after modeling,and the differences were statistically significant(all P＜0.05).The results of the confocal microscope examination on Day 35 after modeling showed that,compared with other groups,there were a large number of globular immune cells and activated stromal cells with unclear boundaries and irregu-lar sizes in the stromal layer and inflammation in the area with irregular intercellular space in the model group and the sham acupuncture group.In the acupuncture group,the morphology of stromal layer cells improved,the cells were slightly acti-vated,and there were no obvious abnormalities in the corneal nerve morphology.On the 35th day after modeling,the re-sults of the light microscope showed that,the surface of the corneal tissue in the model group and the sham acupuncture group showed hyperkeratinized flat epithelial cells,lymphocyte infiltration,increased number of focal epithelial cell layers,and epithelial cell detachment.In the acupuncture group,there were 4-6 layers of epithelial cells in the corneal epitheli-um,and epithelial shedding decreased.In addition,the lymphocyte infiltration decreased compared with the model group.On the 35th day after modeling,the results of the transmission electron microscope showed that abnormal microvilli oc-curred and epithelial cells were absent in the corneal epithelial cells of rabbits in the model group and the sham acupuncture group,the cell space was widened,the rough endoplasmic reticulum was severely expanded,and desmosomes were dis-banded with mitochondrial swelling.In the acupuncture group,the microvilli structure of epithelial cells was sparse and short,local deletion was still observed,the rough endoplasmic reticulum was slightly expanded,and no obvious swelling of mitochondria was observed.On the 35th day after modeling,the Western blot examination results showed that,compared with the blank group,the expression of p-NF-κB p65 was up-regulated in both the model group and sham acupuncture group(both P＜0.05);compared with the model group and sham acupuncture group,the expression of p-NF-κB p65 in the acupuncture group was down-regulated(both P＜0.05).Conclusion Acupuncture can inhibit the NF-κB signaling path-way to play an anti-inflammatory role and relieve corneal inflammation and injury of dry eye rabbit models.
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Objective To investigate the influence factors of abnormal posterior corneal surface elevation of myopia patients under normal corneal biomechanical state.Methods A retrospective case-control study was conducted.A total of 99 myopia patients(99 right eyes)who were going to undergo refractive surgery in Nanjing Aier Eye Hospital from April 2022 to December 2022 were included.All patients received routine preoperative examinations,and the corneal morphologi-cal and biomechanical examinations were performed by Pentacam combined with Corvis ST.For patients with normal Cor-vis biomechanical index(CBI,corneal biomechanical indexes measured by Corvis ST),corneal back difference(BD,difference between the enhanced posterior surface elevation and the normal posterior surface elevation)obtained by BADⅢ-Belin/Ambrósio Enhanced Ectasia Display(BAD)of the Pentacam 3D anterior segment analysis system was used to di-vide the posterior corneal surface elevation into group A(BD＜12 μm,33 patients,33 eyes,control group),group B(12μm≤BD≤16 μm,32 patients,32 eyes,suspicious corneal abnormality group),and group C(BD＞16 μm,34 patients,34 eyes,corneal abnormality group).Basic information about the patients,such as gender and age,was collected;ocular pa-rameters,such as intraocular pressure,spherical equivalent(SE),thinnest pachymetry(THP)and anterior chamber depth(ACD),were included;corneal morphological parameters obtained by Pentacam,such as corneal horizontal diameter(HWTW),BD,anterior Sim Ks(ASK),posterior Sim Ks(PSK),BAD system-related indicators[including deviation of normality of the front elevation(Df),deviation of normality of pachymetric progression(Dp),deviation of normality of corneal thinnest point(Dt),and overall deviation of normality(Do)]and pachymetric progression index(PPI),were en-rolled;corneal biomechanical integration parameters obtained by Corvis ST,such as stiffness parameters,integrated radius(IR,area under the inverse concave radius curve),Ambrósio relational thickness to the horizontal profile(ARTh,THP/thickness change rate)and deformation amplitude ratio,were included.The comparison between groups was conducted with one-way ANOVA test and H test,Spearman Correlation was used to analyze the correlation between the BD and ocular parameters in each group,and a multivariate logistic regression model was used to explore the main factors affecting the classification of BD values under normal corneal biomechanical state.The probability distribution of abnormal posterior corneal surface elevation under normal corneal biomechanical state was plotted according to the logistic regression equa-tion,and then the receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of the logistic regression equation.Results There were statistically significant differences in THP,HWTW,PSK,Df,Dp,Dt,Do,PPImin,PPIavg,ACD,Db and ARTh among the three groups(all P＜0.05);in pairwise comparisons,only PSK(F=11.385),Db(H=87.107),Do(F=50.051)and PPImin(F=16.556)showed statistically significant differences(allP＜0.01),and the other parameters only showed statistically significant differences between Group A and Group B,Group A and Group C(all P＜0.05).The BD of the three groups were highly positively correlated with Db(r=0.957,0.914 and 0.952,all P＜0.05).In addition,the BD in Group A was slightly negatively correlated with PSK(r=-0.437,P＜0.05)and slightly positively correlated with Do(r=0.432,P＜0.05);the BD in Group C showed a low degree of negative corre-lation with SE(r=-0.399,P＜0.05)and a moderate negative correlation with HWTW(r=-0.482,P＜0.05).Using BD as the dependent variable and other parameters as covariates for multivariate logistic regression,the results showed that the influencing factors of BD in Group B were THP,HWTW and ARTh,the influencing factors of BD in Group C were THP,HWTW,ARTh and IR,and the overall percentage of model classification was 72.7％.According to ROC curve analysis,the new parameter Logistic(C)in multivariate logistic regression could improve the diagnostic efficiency of normal corneal bio-mechanical parameters with abnormal corneal posterior surface elevation,and its area under the curve(sensitivity,speci-ficity)was 0.975(100.0％,90.9％).Conclusion THP,HWTW,ARTh and IR are the main influencing factors of ab-normal posterior corneal surface elevation in myopic patients under normal corneal biomechanical state;the influence of corneal morphological and biomechanical parameters should be considered when diagnosing the abnormal posterior corneal surface elevation.
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AIM: To analyze the corneal morphological characteristics of school-age children, and provide reference for the examination of refractive errors, corneal lesions, and treatment in school-age children.METHODS: Children aged 6-12 years in our hospital from March 2020 to June 2023 were included as the research objects, and they are divided into emmetropia group(-0.25 D≤SE≤+0.25 D)and myopia group(-6.00 D≤SE<-0.25 D)according to spherical equivalent(SE). The flat curvature(K1), steep curvature(K2), mean curvature(Km), radius of curvature(Rm), white-to-white(WTW)and corneal central thickness(CCT)were measured by Pentacam anterior segment analyzer. The corneal morphological differences between the emmetropia group and myopia group, boys and girls and children of different ages were analyzed.RESULTS: In the emmetropia group, the anterior corneal surface Km was 42.84±0.61 D, Rm was 7.85±0.15 mm, the posterior corneal surface Km was -6.23±0.04 D, Rm was 6.77±0.15 mm, WTW was 11.89±0.28 mm, CCT was 557.77±22.44 μm; in the myopia group, Km was 43.68±0.62 D, Rm was 7.72±0.16 mm, Km was -6.49±0.03 D, Rm was 6.64±0.17 mm, WTW was 12.17±0.27 mm, CCT was 553.24±22.23 μm. There was significant difference in corneal morphology between the emmetropia group and the myopia group(both P<0.01). Correlation analysis showed that corneal morphology was significantly correlated with age and gender.CONCLUSION: The corneal morphology of school-age children is not fixed, and the occurrence of myopia is not only related to the growth of axial length, but also significantly related to the changes of corneal morphology.
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@#AIM: To investigate the effects of long-term orthokeratology lens wearing on corneal morphology, corneal biomechanics and objective visual quality.METHODS: A retrospective study was conducted to collect 33 myopic patients(60 eyes), including 19 males(35 eyes)and 14 females(25 eyes), mean age 11.80±1.51 years old, with an average equivalent spherical lens of -3.25±0.69D, who had been wearing orthokeratology lens for 2a from October 2019 to December 2020 in our hospital. Relevant data were collected before wearing and 2a after wearing. The radius of curvature(ARC and PRC), the thickness of the thinnest cornea(THP)and the index of comprehensive deviation analysis of corneal dilation(BADD)were measured by Pentacam anterior segment analysis system. Corvis ST biomechanical analyzer measured non-contact biomechanical corrected intraocular pressure(blOP), maximum deformation amplitude(DA), maximum reverse radius(HCR), ratio of deformation amplitude between apex and 1mm(DR), hardness parameters(SPA1), and corneal biomechanical parameters(CBI). The biomechanical index(TBI)of CT scan was obtained by the combined diagnosis system of Pentacam and Corvis ST. OQAS-II objective visual quality analysis system measured modulation transfer function cutoff frequency(MTF cutoff), Stryl ratio(SR), objective scattering coefficient(OSI)and OV value(OV100%, OV20% and OV9%). The above parameters were compared before and continuously wearing orthokeratoscope for 2a. RESULTS: After 2a of wearing orthokeratology, ARC increased, THP decreased, and BADD increased(<i>t</i>=-9.38, 2.85, -13.08; all <i>P</i><0.05), while there was no significant difference between PRC and before wearing(<i>t</i>=1.49, <i>P</i>>0.05). DA increased and HCR decreased compared with before wearing orthokeratology lens(<i>t</i>=-2.37, 2.28; all <i>P</i><0.05), but bIOP, DR, SPA1, CBI and TBI showed no difference(<i>t</i>=1.36, -1.87, 1.27, -0.95, -1.49; all <i>P</i>>0.05). SR was higher than before, OV20% and OV9% were lower than before(<i>t</i>=-5.31, 8.37, 2.34; all <i>P</i><0.05), MTF cutoff, OSI and OV100% had no difference compared with before(<i>t</i>=-1.57, -1.35, 1.11; all <i>P</i>>0.05).CONCLUSION: Long-term wearing of orthokeratology lens changed the morphology of the anterior corneal surface, but had no significant effect on the corneal biomechanics, and the objective visual quality of patients was improved during the day, but decreased at night.
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@#AIM: To investigate the early corneal morphological changes and the possible influenced factors of small incision lenticule extraction(SMILE)combined with corneal collagen cross-linking(CXL)in the treatment of refractive error.<p>METHODS: This was a retrospective case study. The patients(76 eyes)with ametropia who had undergone SMILE surgery in our hospital from September 2018 to March 2019 were small age, high degree of severity, thin cornea or irregular shape. The patients were divided into the SMILE combined with CXL group with 17 patients(32 eyes)and the SMILE group with 22 patients(44 eyes). The corneal morphological parameters of the two groups were measured preoperatively and 1mo postoperatively. <p>RESULTS: There were significant statistically differences in the changes of K1, K2, Km, central corneal thickness, posterior corneal elevation, anterior corneal elevation parameters, posterior corneal elevation parameters, the D value and index of vertical asymmetry(IVA)between these two groups(<i>P</i><0.05), while there were no significant statistically difference in the changes of index of highest decentration(IHD)(<i>P</i>>0.05). The changes of some parameters of the corneal anterior surface morphology of the two groups were correlated with the corneal cutting depth, spherical equivalent and optical zone diameter(<i>P</i><0.05). While the changes of some parameters of the corneal posterior surface morphology were not correlated with the corneal cutting depth, spherical equivalent,and optical zone diameter(<i>P</i>>0.05). There was no apparent correlation between the changes of corneal surface morphology and the cross-linking depthin SMILE combined with CXL group(<i>P</i>>0.05). <p>CONCLUSION: SMILE combined with CXL was applied to the high-risk patients with small age, high degree of severity, thin cornea or irregular shape, which increased its safety and effectiveness. SMILE combined with CXL didn't make significant effects on the posterior surface morphology of the cornea, but it influenced the anterior surface morphology. The influenced factors may be related to the corneal cutting depth, the spherical equivalent and the optical zone diameter.
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@#AIM: To explore the correlation between eccentricity in the optical treatment area and tear film function and corneal morphology after orthokeratology. <p>METHODS:Eighty patients(80 eyes)with myopia who were treated with orthokeratology were selected as subjects. The eccentric distance, tear film function and corneal morphology of the patient's optical treatment area were detected at different time points before and after wearing the lens. According to the median eccentric distance, the patients were divided into low eccentricity group and high eccentricity group. The differences of tear film function and corneal morphology at different time points before and after wearing were compared between the two groups. Pearson correlation coefficient was used to analyze the correlation between total eccentricity and tear film function and corneal morphological parameters at 12mo after wearing glasses. <p>RESULTS:Compared with before wearing lenses, the corneal surface asymmetry index and corneal surface regularity index of the two groups were significantly increased at 1wk, 3, 6 and 12mo after wearing lenses(<i>P</i><0.05). Patients in the high eccentric group were more significantly elevated than in the lower eccentric group, and the differences were statistically significant(<i>P</i><0.05). The time of tear film rupture, corneal curvature, basic tear secretion, and central corneal thickness were significantly lower, and the differences were statistically significant(<i>P</i><0.05). Compared with the patients with lower eccentricity, the patients with high eccentricity group had more significant reduction in tear film rupture time and basic tear secretion, and the difference was statistically significant(<i>P</i><0.05), however, the degree of corneal curvature and central corneal thickness decreased less(<i>P</i><0.05). There was no significant difference in corneal endothelial cell density between 1wk after wearing lenses and 3mo after wearing lenses(<i>P</i>>0.05). The difference was statistically significant at 6mo and 12mo after wearing lenses(<i>P</i><0.05). At 12mo after wearing the lens, the total eccentric distance was positively correlated with the asymmetry index of the corneal surface and the regularity index of the corneal surface(<i>r</i>=0.869, 0.815; <i>P</i><0.05). At 12mo after wearing the lens, the total eccentric distance was negatively correlated with tear film rupture time, corneal curvature, basic tear secretion, and central corneal thickness(<i>r</i>=-0.865, -0.745, -0.912, -0.713; all <i>P</i><0.05), and there was no significant correlation with corneal endothelial cell density(<i>r</i>=0.185, <i>P</i>=0.199). <p>CONCLUSION:The eccentricity of the optical treatment area occurs at the beginning of wearing lenses. And the total eccentric distance has a significant correlation with the changes of tear film function and corneal morphology after keratoplasty.
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AIM: To investigate the changes and effects of orthokeratology on corneal morphology. METHODS: Totally 90 patients were treated with orthokeratology from January 2015 to December 2016. They were divided into observation group (overnight wearing) and control group(daytime wearing),45 cases (90 eyes) in each. The central corneal thickness, corneal curvature, spherical equivalent (SE), uncorrected visual acuity (UCVA) of both groups were compared before and after wearing orthokeratology lens for 1wk,1,3,and 6mo. RESULTS: The central corneal thickness of two groups before wearing glasses was significantly higher than that of the cornea after wearing glasses 1wk,1,3 and 6mo(all P<0.05); the central corneal thickness of the observation group at 1, 3 and 6mo after wearing glasses was significantly lower than that of the control group (P<0 05). The corneal curvature values of the two groups before wearing glasses were significantly higher than that of the cornea after wearing for 1wk,1,3 and 6mo (all P<0.05). The corneal curvature of observation group at 6mo was significantly lower than that of the control group (40.0士0.5D vs 41.3士0.9D, P<0.05). The staining rate of corneal epithelium was observed at 3mo after wearing glasses. The positive rate of epithelial staining was 49% (44/90) in the observation group and 29% (26/90) in the comparison group;the grade 0,grade 1 accounted for the majority of the two groups. With the orthokeratology lens wearing longer, the SE level of two groups showed a downward trend. The spherical equivalent of observation group at 6mo was significantly lower than that of the control group (-0.42士0.20D vs -0 52士0.19D, P<0.05). The UCVA value of two groups after wearing glasses significantly increased than that before wearing glasses (all P<0.05). CONCLUSION: Wearing orthokeratology lens can reduce myopia degree. Wearing it overnight has the better outcome than wearing in the daytime.