Comparison of safety and effectiveness of micropulse transscleral cyclophotocoagulation and "slow cook" diode laser transscleral cyclophotocoagulation in patients with refractory open-angle glaucoma

ABSTRACT Purpose: This study aimed to compare the safety and effectiveness of intraocular pressure reduction between micropulse transscleral cyclophotocoagulation and "slow cook" transscleral cyclophotocoagulation in patients with refractory primary open-angle glaucoma. Methods: We included patients with primary open angle glaucoma with at least 12 months of follow-up. We collected and analyzed data on the preoperative characteristics and postoperative outcomes. The primary outcomes were a reduction of ≥20% of the baseline value (criterion A) and/or intraocular pressure between 6 and 21 mmHg (criterion B). Results: We included 128 eyes with primary open-angle glaucoma. The preoperative mean intraocular pressure was 25.53 ± 6.40 and 35.02 ± 12.57 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean intraocular pressure was reduced significantly to 14.33 ± 3.40 and 15.37 ± 5.85 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups at the last follow-up, respectively (p=0.110). The mean intraocular pressure reduction at 12 months was 11.20 ± 11.46 and 19.65 ± 13.22 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The median preoperative logMAR visual acuity was 0.52 ± 0.69 and 1.75 ± 1.04 in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean visual acuity variation was −0.10 ± 0.35 and −0.074 ± 0.16 in the micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p=0.510). Preoperatively, the mean eye drops were 3.44 ± 1.38 and 2.89 ± 0.68 drugs in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p=0.017), but those were 2.06 ± 1.42 and 1.02 ± 1.46 at the end of the study in the "slow cook" and micropulse transscleral cyclophotocoagulation groups, respectively (p<0.001). The success of criterion A was not significant between both groups. Compared with 11 eyes (17.74%) in the "slow cook" transscleral cyclophotocoagulation group, 19 eyes (28.78%) in the micropulse transscleral cyclophotocoagulation group showed complete success (p=0.171). For criterion B, 28 (42.42%) and 2 eyes (3.22%) showed complete success after micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p<0.001). Conclusion: Both techniques reduced intraocular pressure effectively.

Intraocular pressure modulation with thermal stimuli

ABSTRACT Purpose: This study aimed to determine whether early-stage intraocular pressure can be modulated using a thermal face mask. Methods: In this prospective clinical study, healthy participants were randomized on a 1:1:1 allocation ratio to three mask groups: hypothermic (G1), normothermic (G2), and hyperthermic (G3). After randomization, 108 eyes from 108 participants were submitted to clinical evaluations, including measurement of initial intraocular pressure (T1). The thermal mask was then applied for 10 minutes, followed by a second evaluation of intraocular pressure (T2) and assessment of any side effects. Results: The hypothermic group (G1) showed a significant reduction in mean intraocular pressure between T1 (16.97 ± 2.59 mmHg) and T2 (14.97 ± 2.44 mmHg) (p<0.001). G2 showed no significant pressure difference between T1 (16.50 ± 2.55 mmHg) and T2 (17.00 ± 2.29 mmHg) (p=0.054). G3 showed a significant increase in pressure from T1 (16.53 ± 2.69 mmHg) to T2 (18.58 ± 2.95 mmHg) (p<0.001). At T1, there was no difference between the three study groups (p=0.823), but at T2, the mean values of G3 were significantly higher than those of G1 and G2 (p<0.00). Conclusion: Temperature was shown to significantly modify intraocular pressure. Thermal masks allow the application of temperature in a controlled, reproducible manner. Further studies are needed to assess the duration of these effects and whether they are reproducible in patients with pathologies that affect intraocular pressure.

Night-time blood pressure dipping, but not 24-h blood pressure level, is linked to increased 24-h ocular volume slope

ABSTRACT Purpose: This study investigated the relationship between blood pressure and intraocular pressure in treatmentnaive, non-glaucoma patients with different blood pressure statuses, focusing on the 24-h ocular volume and nocturnal blood pressure decline. Methods: Treatment-naive, non-glaucoma patients undergoing hypertension evaluation were enrolled as study participants. Simultaneous 24-h ambulatory blood pressure measurement and 24-h ocular volume recording with a contact lens sensor. We also compared ocular volume curve parameters between normotensive and hypertensive patients, as well as between those with and without nocturnal blood pressure decline. Results: A total of 21 patients, including 7 normotensive and 14 treatment-naive hypertensive individuals, were included in the study. of them, 11 were dippers and 10 were non-dippers. No significant difference in the 24-h ocular volume slope was observed between the hypertensive and normotensive patients (p=0.284). However, dippers had a significantly higher 24-h ocular volume slope (p=0.004) and nocturnal contact lens sensor output (p=0.041) than non-dippers. Conclusion: Nocturnal blood pressure decline, rather than the blood pressure level, is associated with the increased 24-h ocular volume slope and nocturnal ocular volume. Further studies are required to determine whether the acceleration of glaucoma progression in dippers is primarily due to low blood pressure, high intraocular pressure, or a combination of both.

Evolución de pacientes intervenidos por trabeculectomía en el Centro Oftalmológico de Santiago de Cuba

Introducción: El glaucoma es una de las entidades nosológicas con mayor prevalencia y constituye una de las principales causas de ceguera en el mundo desarrollado. La presión intraocular es el único factor de riesgo que puede ser controlado y se asocia a la presencia y progresión de la enfermedad. Objetivo: Describir la evolución de pacientes operados mediante la técnica de trabeculectomía. Métodos: Se realizó un estudio observacional descriptivo, longitudinal y prospectivo de 128 pacientes con glaucoma crónico simple operados mediante la técnica de trabeculectomía en el Centro Oftalmológico de Santiago de Cuba, desde enero del 2017 hasta junio del 2019. Para ello, se analizaron las siguientes variables: edad, sexo, color de piel, agudeza visual preoperatoria y posoperatoria, presión intraocular antes y después de la operación, así como complicaciones posoperatorias. Resultados: Predominaron el sexo masculino (69,5 %), el grupo etario de 60-69 años (44,5 %) y el color de la piel negro (53,1 %). La hipertensión arterial fue la enfermedad asociada con más frecuencia y la hipertensión ocular, el factor de riesgo fundamental; en tanto, la complicación posoperatoria principal fue el hipema. Conclusiones: Con la trabeculectomía se logró controlar la tensión ocular en la mayoría de los pacientes y las complicaciones que se presentaron en algunos de ellos no interfirieron en su evolución. Esta técnica permitió disminuir el daño irreversible que provoca la hipertensión ocular del nervio óptico y, por consiguiente, prevenir la ceguera.

Introduction: Glaucoma is one of the nosologic entities with more prevalence and constitutes one of the main causes of blindness in the developed world. The intraocular pressure is the only risk factor that can be controlled and is associated with the presence and progression of the disease. Objective: To describe the evolution of patients operated by means of trabeculectomy technique. Methods: An observational descriptive, longitudinal and prospective study of 128 patients with simple chronic glaucoma operated by means of trabeculectomy technique was carried out in the Ophthalmology Center of Santiago de Cuba, from January, 2017 to June, 2019. For this purpose, the following variables were analyzed: age, sex, skin color, preoperative and postoperative visual acuteness, intraocular pressure before and after the operation, as well as postoperative complications. Results: There was a prevalence of male sex (69.5%), 60-69 age group (44.5%) and black skin color (53.1%). Hypertension was the most frequent associated disease and the ocular hypertension was the fundamental risk factor; meanwhile, the main postoperative complication was the hyphema. Conclusions: With trabeculectomy was possible to control ocular tension in most of the patients and the complications that were presented in some of them did not interfere in their clinical course. This technique made it possible to reduce the irreversible damage caused by ocular hypertension of the optic nerve and, consequently, to prevent blindness.

In vitro human lymphocyte proliferation assay under different extraction conditions and doses of two types of test samples / 中国组织工程研究

BACKGROUND:In vitro lymphocyte proliferation test is often used to detect the potential immunogenicity of medical devices,but no detailed extraction conditions and dose are given in the relevant standards. OBJECTIVE:To investigate the effects of different extraction conditions of the test product and different doses of the extract on in vitro human lymphocyte proliferation,and to consider the factors that need to be considered when selecting test conditions for in vitro lymphocyte proliferation test. METHODS:In the experiment,the homogenous bone repair material and heparin-modified intraocular lens were divided into the following 12 groups:(1)Experimental group 1:24-hour complete medium(RPMI modified medium containing 10%fetal bovine serum)extract of 200 μL + lymphocyte suspension of 50 μL;(2)negative control group 1:24-hour complete medium 200 μL + lymphocyte suspension 50 μL;(3)experimental group 2:24-hour complete medium extract 100 μL + lymphocyte suspension 100 μL;(4)negative control group 2:24-hour complete medium 100 μL + lymphocyte suspension 100 μL;(5)experimental group 3:72-hour RPMI modified medium extract(addition of 10%fetal bovine serum before experiment)200 μL + lymphocyte suspension 50 μL;(6)negative control group 3:72-hour RPMI modified medium(addition of 10%fetal bovine serum before experiment)200 μL + lymphocyte suspension 50 μL;(7)experimental group 4:72-hour RPMI modified medium extract(addition of 10%fetal bovine serum before experiment)100 μL + lymphocyte suspension 100 μL;(8)negative control group 4:72-hour RPMI modified medium(addition of 10%fetal bovine serum before experiment)100 μL + lymphocyte suspension 100 μL;(9)positive control group 1:complete medium containing 10 μg/mL plant hemagglutinin-M 200 μL + lymphocyte suspension 50 μL;(10)positive control group 2:complete medium containing 10 μg/mL plant hemagglutinin-M 100 μL + lymphocyte suspension 100 μL;(11)blank control group 1:250 μL complete medium;(12)control group 2:200 μL complete medium.After 3 days of culture,the proliferation of lymphocytes was detected by CCK-8 assay. RESULTS AND CONCLUSION:(1)Under different test conditions,the extracts of the allogeneic bone repair material could enhance the activity of human lymphocytes.Under the condition of 72-hour leaching in RPMI modified medium and the volume ratio of leaching solution and lymphocyte suspension was 4:1,the most significant effect was observed.Heparin-modified intraocular lens extract also had obvious inhibitory effect on lymphocyte activity under this condition;its inhibitory effect on lymphocyte activity may be related to the heparin in the extract.However,the activity of lymphocytes was slightly enhanced by heparin-modified intraocular lens extract under the experimental conditions of complete medium extraction for 24 hours and the volume ratio of extract to lymphocyte suspension was 4:1.(2)Under different extraction conditions and doses,the results of in vitro lymphocyte proliferation test may be quite different.The selection of test conditions should be combined with the clinical application of the product,and the inherent characteristics of the product should also be considered.

Comparison of 25G+and 27G+pars plana vitrectomy in the treatment of idiopathic epiretinal membrane / 新乡医学院学报

Objective To compare the clinical efficacy of 25G+and 27G+pars plana vitrectomy(PPV)in the treat-ment of idiopathic epiretinal membrane(iERM).Methods A total of 50 iERM patients(50 eyes)who were admitted to the Third Affiliated Hospital of Xinxiang Medical University from December 2019 to August 2022 were selected as the research subjects.These patients were divided into the control group and observation group based on different surgical methods,with 25 patients(25 eyes)in each group.Patients in the control group received 25G+PPV treatment,while patients in the observation group received 27G+PPV treatment.The surgical duration and postoperative 1-day incision subconjunctival hemorrhage and e-dema of patients in two groups were compared;central macular thickness(CMT)was measured by optical coherence tomo-graphy before surgery,1 day,1 week,1 month,and 3 months postoperatively in the two groups.Visual acuity of patients in both groups was assessed according to the early treatment diabetic retinopathy study(ETDRS)visual acuity chart.Intraocular pressure was measured by using a non-contact Callon tonometer.Complications,such as intraoperative macular injury,retinal hole,postoperative choroidal detachment,retinal hemorrhage,retinal detachment,and intraocular infection,were observed in both groups.Results The surgical duration of patients in the observation group was significantly shorter than that in the control group(t=2.314,P＜0.05).The extent of subconjunctival hemorrhage and edema of patients in the observation group was significantly smaller than that in the control group(t=13.706,P＜0.01).The ETDRS visual acuity of patients at 1 day,1 week,1 month,and 3 months after surgery in both groups was significantly higher than that before surgery(P＜0.05).There was no signifi-cant difference in ETDRS visual acuity of patients between the two groups at 1 day,1 week,1 month,and 3 months postoperatively(P＞0.05).At 1 day after surgery,the intraocular pressure of patients in the observation group was significantly higher than that in the control group(P＜0.05).At 1 week,1 month,and 3 months after surgery,there was no significant difference in intraocular pressure of patients between the two groups(P＞0.05).Two patients in the control group experienced transient ocular hypotension 1 day after surgery,while no such complication was observed in the observation group.Patients in both groups presented with varying degrees of retinal nerve epithelial layer traction,retinal edema,thickening,and vascular distortion before surgery.At 1 day after surgery,epiretinal membrane traction was relieved in both groups,and there was a significant improvement in the anatomical structure of the macular area compared to preoperative conditions.At 1 day,1 week,1 month,and 3 months after surgery,the CMT of patients in both groups was reduced compared to preoperative values(P＜0.05);there was no significant difference in CMT of patients between the two groups at 1 day,1 week,1 month,and 3 months after surgery(P＞0.05).In the control group,18 eyes(72.0％)were sutured at the scleral puncture sites due to leakage,while no suturing was performed in the observation group.Patients in both groups completed the surgery successfully,without any intraoperative complications such as macular injury or retinal hole.During the 3-month follow-up,no postoperative complications such as choroidal detachment,retinal hemorrhage,retinal detachment,or intraocular infection were observed in both groups.Conclusion Both 27G+PPV and 25G+PPV have good clinical effects and high surgical safety in the treatment of iERM.Compared with 25G+PPV,27G+PPV can shorten the surgical duration,better maintain postoperative intraocular pressure stability,and reduce the range of subconjunctival bleeding and edema.

Effect of residual corneal astigmatism on visual acuity of patients undergoing regional refractive intraocular lens implantation / 眼科新进展

Objective To investigate the effect of residual corneal astigmatism on visual acuity after regional refrac-tive intraocular lens(IOL)implantation.Methods A retrospective cohort study was conducted.The medical records and follow-up data of 73 eyes of 57 cataract patients who underwent ultrasound emulsification cataract extraction combined with LENTIS Comfort LS-313 MF15 IOL implantation in the Ophthalmology Department of the Hebei General Hospital from June 2020 to March 2022 were collected.These patients were grouped according to postoperative residual corneal astigmatism:32 patients(40 eyes)with a residual corneal astigmatism of 0.75(exclusive)-1.50 D were taken as the experimental group,and 25 patients(33 eyes)with a residual corneal astigmatism ≤0.75 D were taken as the control group.The uncor-rected distance visual acuity(5 m),uncorrected intermediate visual acuity(80 cm),uncorrected near visual acuity(40 cm),out-of-focus curve,objective visual quality,subjective visual quality,satisfaction degree and lens removal rate of pa-tients in the two groups were recorded 6 months postoperatively.Results The postoperative uncorrected distance visual acuity(logMAR)was 0.10(0.00,0.22),the uncorrected intermediate visual acuity(logMAR)was 0.00(0.00,0.10),and the uncorrected near visual acuity(logMAR)was 0.20(0.10,0.30)and 0.20(0.10,0.20)in the experimental and control groups,with no statistically significant differences(all P＞0.05).The postoperative out-of-focus curves showed that the distance visual acuity of patients with additional spherical equivalent refraction ranged from+2.00 D to-4.00 D in the two groups had no statistically significant difference(all P＞0.05).There were statistically significant differences in to-tal aberration,coma aberration,modulation transfer function and Strehl ratio in the objective visual quality of patients after surgery(all P＜0.05),and there was no statistically significant difference in the total higher-order aberration,spherical ab-erration and cloverleaf aberration(all P＞0.05).There was no statistically significant difference in the subjective visual quality,satisfaction degree and lens removal rate in the two groups(all P＞0.05).Conclusion Residual corneal astig-matism of 0.75 D to 1.50 D after LENTIS Comfort LS-313 MF15 IOL implantation has no effect on higher-order aberration,spherical aberration,and cloverleaf aberration in subjective and objective visual quality,and has an impact on total aberra-tion,coma aberration,modulation transfer function and Strehl ratio in objective visual quality.

Regulatory effect of autonomic nerve on aqueous humor outflow pathway / 眼科新进展

Glaucoma is the leading irreversible blinding eye disease worldwide,and intraocular pressure(IOP)plays a key role in the occurrence and development of glaucoma.However,the underlying IOP regulatory mechanism remains un-clear.Currently,clinical IOP-lowering drugs work either by reducing aqueous humor formation or increasing aqueous hu-mor outflow with limited reduction amplitude.Recent studies demonstrate that IOP may be regulated by autonomic nerves.To understand the distribution and regulatory mechanism of autonomic nerves in the aqueous humor outflow pathway and provide new ideas for IOP-lowering study and novel drug exploration,we review the roles of the autonomic nervous system in the formation and outflow of aqueous humor in this article.

Comparison of 1-year postoperative clinical effects between sutureless bridge intrascleral fixation and ciliary sulcus suture suspension of intraocular lens / 眼科新进展

Objective To compare the clinical effects between sutureless bridge intrascleral fixation and ciliary sul-cus suture suspension of intraocular lens(IOL)1 year postoperatively.Methods In this retrospective study,14 patients(14 eyes)who underwent sutureless bridge intrascleral IOL fixation in the No.988 Hospital of Joint Logistic Support Force of PLA from March 2019 to January 2022 were taken as the intrascleral fixation group and 15 patients(15 eyes)who under-went IOL ciliary sulcus suture suspension in the same period were taken as the suture suspension group.During the 1-year follow-up,the preoperative and postoperative uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA)(logMAR),spherical equivalent(SE),endothelial cell count(ECC),intraocular pressure(IOP)and IOL position were compared between the two groups.Results At 1,6 and 12 months postoperatively,the UCVA in both groups significant-ly increased compared with those before surgery(all P＜0.05),and UCVA in the intrascleral fixation group were better than those in the suture suspension group at all postoperative time points(F=4.560,6.411 and5.373;all P＜0.05).At 1,6 and 12 months postoperatively,there was no significant difference in BCVA in both groups compared with those before surgery(all P＞0.05),but BCVA in the intrascleral fixation group were better than those in the suture suspension group at all postoperative time points(F=6.170,6.957 and 10.624;all P＜0.05).After surgery,eyes in the intrascleral fixation group showed hyperopia drift,while eyes in the suture suspension group showed myopia drift.At 1,6 and 12 months post-operatively,the SE of the intrascleral fixation group were(0.59±0.30)D,(0.57±0.27)D and(0.64±0.29)D,respec-tively,and those of the suture suspension group were(-0.75±0.44)D,(-0.72±0.42)D and(-1.12±0.64)D,re-spectively.At 6 months postoperatively,the ECC of both groups were significantly lower than those before surgery(t=8.579 and 21.929;both P＜0.001).The IOP in both groups were within the normal range preoperatively and stable during the follow-up.The IOL were centrally located without obvious decentration or tilt during the follow-up.In addition,there were no vitreous and retinal complications.Conclusion Both sutureless bridge intrascleral IOL fixation and IOL ciliary sulcus suture suspension can obtain a favorable prognosis of visual acuity with refractive shift,while sutureless bridge in-trascleral fixation shows better clinical outcomes.

Tilt and decentration of intraocular lens after four-point suspension fixation and their relationship with visual prognosis / 眼科新进展

Objective To compare and analyze the tilt and decentration of the intraocular lens in patients receiving four-point and two-point suspension fixation,as well as their relationship with visual prognosis.Methods A total of 80 patients(80 eyes)who underwent intraocular lens suspension fixation at the Ophthalmology Department of Baoding No.1 Central Hospital from June 2021 to April 2022 were selected as the subjects.These patients were randomly divided into the experimental group(41 patients,41 eyes,underwent four-point suspension fixation)and the control group(39 patients,39 eyes,underwent traditional two-point suspension fixation).They were followed up for at least 6 months after surgery to re-cord their uncorrected visual acuity(UCVA)and best corrected visual acuity(BCVA)before surgery and at the last follow-up.The tilt angle and decentration distance of the intraocular lens of patients in the two groups were measured after surger-y by a panoramic ultrasound biomicroscope.The preoperative and last follow-up UCVA and BCVA of patients in the two groups,as well as tilt angle and decentration distance of the intraocular lens after surgery,were compared,and the corre-lation between tilt angle,decentration distance and postoperative UCVA,BCVA was analyzed by Person correlation analy-sis.Results The UCVA and BCVA at the last follow-up in the experimental group and control group were better than those before surgery(all P＜0.05).The difference in postoperative UCVA between the experimental group and the control group was statistically significant(t=-6.20,P=0.00),and the experimental group had better postoperative UCVA than the control group.There was no statistically significant difference in postoperative BCVA between the experimental group and the control group(t=-1.43,P=0.16).The postoperative horizontal and vertical tilt angles of the intraocular lens in the experimental group were 0.70°±0.24° and 0.60°±0.16°,respectively;while those in the control group were 2.66°± 1.40° and 3.76°±0.67°,respectively.The differences between the two groups were statistically significant(t=-8.51 and-29.42,P=0.00 and 0.00).The postoperative horizontal and vertical decentration distances of the intraocular lens in the experimental group were(0.24±0.10)mm and(0.25±0.10)mm,respectively,while those in the control group were(0.85±0.77)mm and(2.14±0.50)mm,respectively.The differences between the two groups were statistically signifi-cant(t=-4.82 and-21.68,P=0.00 and 0.00).In the experimental group,neither the horizontal and vertical tilt angles of intraocular lenses nor the horizontal and vertical decentration distances were correlated with postoperative UCVA and BCVA(all P＞0.05).In the control group,the horizontal tilt angle of intraocular lenses was positively correlated with post-operative UCVA and BCVA(both P＜0.05),while the vertical tilt angle was not correlated with postoperative UCVA and BCVA(both P＞0.05);the horizontal decentration distance was positively correlated with postoperative UCVA and BCVA(both P＜0.05),but the vertical decentration distance was not correlated with postoperative UCVA and BCVA(both P＞0.05).Conclusion Both four-point suspension fixation and traditional two-point suspension fixation can effectively im-prove postoperative vision of patients,while the tilt and decentration of the intraocular lens are smaller after four-point sus-pension fixation.

Analysis of refractive prediction errors after flanged intrascleral intraocular lens implantation / 眼科新进展

Flanged intrascleral intraocular lens implantation has become one of the mainstream treatment solutions for aphakia in clinical practice due to its ability to avoid dislocation of the intraocular lens,or subluxation caused by suture degradation or breakage,as well as the ability to eliminate complications such as inflammation or infection caused by su-tures,and the significant improvement in postoperative vision for patients.However,there has been no systematic analysis of the factors that may lead to postoperative refractive prediction errors in China.This article analyzes the possible prob-lems of flanged intrascleral intraocular lens implantation and the reasons for postoperative refractive prediction errors,in order to provide reference for clinical work.

Focusing on preoperative evaluation for cataractous eyes after implantable collamer lens / 中华实验眼科杂志

With increasing age, more and more patients with posterior chamber intraocular lens (ICL) implantation are facing the threat of cataracts to their visual acuity.When examining the eyes of cataract patients after ICL surgery, attention should be paid to whether the density of corneal endothelial cells is greater than 2 000 cells/mm 2, the state of the anterior chamber angle, and whether there are fundus abnormalities such as retinal detachment and choroidal neovascularization.When conducting eye biometry measurement, attention should be paid to the measurement starting and ending lines of anterior chamber depth and lens thickness.If patients undergo ICL combined with corneal refractive surgery, they should be examined with two or more devices to obtain corneal refractive power according to the examination requirements after corneal laser vision correction.When selecting the type of intraocular lens, consideration should be given to the histological characteristics of high myopia.Compared to C- and L- loops, plate-haptic is relatively more stable in patients with high myopia accompanied by large capsules and larger diameters of continuous curvilinear capsulorhexis.Kane, Barrett Universal Ⅱ, Olsen, Hill-RBF formulas for calculating the refractive power of intraocular lenses are more accurate in people with long axial length.It is recommended to perform ICL removal simultaneously with phacoemulsification and intraocular lens implantation, preferably with a surgical incision greater than 2.6 mm.Femtosecond laser assisted cataract extraction surgery, although superior to traditional phacoemulsification in reducing corneal endothelial cell loss, reducing corneal edema, and high-quality capsulorhexis, can cause incomplete capsulorhexis and fragmentation due to the cavitation bubbles, manual adjustment of location, and the impact of lower vault.It is recommended to use it with caution.Ophthalmologists should fully understand and pay attention to the characteristics and difficulties of cataract surgery after ICL surgery, communicate fully with patients, and make personalized surgery to achieve better visual outcomes.

Evaluation of optical performance of aspherical intraocular lens in vitro by optical bench / 中华实验眼科杂志

Objective:To evaluate the optical performance of two aspheric intraocular lenses (IOL) AcrySof IQ SN60WF and Proming A1-UV with identical negative spherical aberration values, using the optical bench OptiSpheric IOL R&D through an in vitro study. Methods:The optical performance of + 20.0 D blue-light filtering SN60WF and monofocal high-order aspheric non blue-light filtering A1-UV IOL was evaluated through cornea models with the spherical aberration of 0 μm (ISO-1) and + 0.28 μm (ISO-2) under apertures of 3.0 mm and 4.5 mm via the optical bench OptiSpheric IOL R&D.The modulation transfer function (MTF) and USAF 1951 resolution test chart were employed to measure the IOL with centering, decentration of 0.3, 0.5, 0.7, 0.9 and 1.1 mm, as well as tilt of 3°, 5°, 7°, 9° and 11°.The spectral transmittance of IOL was measured with the UV-3300 UV-VIS spectrophotometer.Results:Compared with the A1-UV IOL, the spectral transmittance of SN60WF for blue light with wavelengths of 400-500 nm was significantly reduced, which effectively reduced the passage of blue light.At an aperture of 3.0 mm, the MTF values at 100 lp/mm spatial frequency for the centered SN60WF and A1-UV were 0.576 and 0.598 under ISO-1 corneal measurement conditions, 0.564 and 0.563 under ISO-2 conditions.At an aperture of 4.5 mm, the MTF values were 0.238 and 0.404 under ISO-1 corneal measurement conditions, and 0.438 and 0.339 under ISO-2 conditions.The MTF values of A1-UV and SN60WF at 3.0 mm aperture and 100 lp/mm spatial frequency under ISO-1 corneal measurement conditions were larger than those under ISO-2 corneal measurement conditions.Under ISO-1 corneal measurement conditions with a 3.0 mm aperture, A1-UV had a better optical quality compared to SN60WF, whereas under ISO-2 corneal measurement conditions, the optical quality of both IOLs was similar.Under the 3.0 mm aperture, the MTF values of SN60WF and A1-UV at a decentration of 0.3 mm and 100 lp/mm spatial frequency were 0.414 and 0.571 under ISO-1 corneal measurement conditions, 0.438 and 0.512 under ISO-2 corneal measurement conditions, respectively.The MTF values of SN60WF and A1-UV at a tilt of 3° were 0.522 and 0.597 under ISO-1 corneal measurement conditions, and 0.532 and 0.531 under ISO-2 corneal measurement conditions.The MTF values and USAF resolution test chart of A1-UV had no significant change between the two corneal measurement conditions.When subjected to equal degrees of decentration or tilting, except for the ISO-1 corneal measurement conditions at a 4.5 mm aperture, the MTF values of A1-UV showed a gradual decline across various spatial frequencies compared to SN60WF.With the increase in aperture size, the impact of IOL decentration or tilting on MTF values and USAF 1951 resolution test chart became more notable for A1-UV relative to SN60WF.Conclusions:The SN60WF IOL effectively filters blue light within the wavelength range of 400-500 nm.However, when both IOL experience decentration greater than 0.3 mm or tilting beyond 3°, the optical quality of the IOL will decline.A1-UV has a distinct advantage over SN60WF in terms of resistance to both decentration and tilting-induced optical performance degradation in vitro.

Evaluation of the efficacy and safety of phacoemulsification under the IOL protection: a randomized controlled clinical study / 中华实验眼科杂志

Objective:To observe the therapeutic effect of intraocular lens (IOL) protected phacoemulsification (PHACO) in patients with hard nucleus cataract.Methods:A randomized controlled clinical study was conducted.A total of consecutive 120 patients (120 eyes) with hard nucleus cataract of Emery grade Ⅳ or Ⅴ were enrolled from January 2019 to May 2022.The patients were randomly divided into PHACO group receiving routine PHACO, IOL protected PHACO group receiving PHACO under IOL protection, and extracapsular cataract extraction (ECCE) group receiving ECCE, with 40 cases (40 eyes) in each group.Finally, 99 patients completed the follow-up, including 30 cases (30 eyes) in PHACO group, 35 cases (35 eyes) in IOL protected PHACO group, and 34 cases (34 eyes) in ECCE group.The total operation time, intraoperative PHACO time and cumulative energy release of each patient were recorded.The corneal endothelial cell density (ECD), coefficient of variation in endothelial cell area (CV), hexagonal endothelial cell ratio (6A), corneal astigmatism and the number of eyes with different grades of uncorrected visual acuity were measured and compared after 3-month follow-up.The intraoperative and postoperative complications were recorded.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Yanbian University Hospital (NO.2023002).Patients were informed of study content and purpose and signed a consent form before treatment.Results:There was no significant difference in ultrasonic energy and time between PHACO group and IOL protected PHACO group ( P=0.691, 0.982).The total operation time was (38.81±2.73) and (36.45±3.45) minutes in PHACO group and IOL protected PHACO group, significantly shorter than (69.60±4.35) minutes in ECCE group (both at P<0.001).There was no significant difference in age, sex, lens nucleus hardness and other baseline data among the three groups before operation (all at P>0.05).Three months after operation, the number of patients with higher uncorrected visual acuity in PHACO group and IOL protected PHACO group was larger than that in ECCE group ( P=0.006, 0.007).The ECD and 6A in IOL protected PHACO group were (2 155.57±177.88)/mm 2 and (41.31±5.18)%, respectively, which were significantly higher than (1 912.64±224.11)/mm 2 and (36.18±3.27)% in PHACO group, and the CV in IOL protected PHACO group was (50.34±5.90)%, which was lower than (55.67±3.30)% in PHACO group, showing statistically significant differences ( P=0.007, 0.003, 0.005).At 1 week and 3 months after the operation, the corneal astigmatism was significantly lower in IOL-protected PHACO group than in ECCE group, but higher than in PHACO group, and the difference were statistically significant (all at P<0.05). Conclusions:Compared with conventional PHACO, IOL-protected PHACO can effectively reduce the damage of corneal endothelium caused by ultrasonic energy, shorten the operation time and reduce postoperative inflammatory reaction compared with ECCE, and does not significantly increase postoperative corneal astigmatism.IOL-protected PHACO is an effective improved surgical method for patients with hard nucleus cataract.

Research progress in the application of in vitro optical quality test system for the assessment of IOL optical quality / 中华实验眼科杂志

Surgery is currently the only effective treatment for cataract.As the standard of living improves, people's demand for postoperative visual quality increases, and a variety of functional artificial lenses (IOL) have been continuously introduced.The in vitro optical quality testing system is used for the design and optimization of new IOL and for the preliminary clinical study of IOL to evaluate the effects of influencing factors such as IOL material, design, decentration, tilt, rotation, incident light wavelength and pupil diameter on the optical quality of IOL.It is helpful for doctors to fully understand and correctly select IOL. In vitro optical quality test systems mainly include optical testing platform and optical design software.The former can experimentally measure IOL, while the latter can perform optical numerical simulation of IOL. In vitro optical quality test systems have received increasing attention in China in recent years.This article reviews the in vitro optical quality test system of IOL and its clinical application.This article reviews the commonly used in vitro optical quality test systems and their clinical applications, including the measurement and evaluation indicators of in vitro optical quality, the construction of optical test platforms (OptiSpheric ? IOL PRO, Badal Optometer, PMTF, and NIMO) and the measurement principles of optical design software (ZEMAX, OSLO, and VirtualLab), as well as their applications in IOL optical quality evaluation and the limitations of in vitro optical testing.

Effect of recombinant human epidermal growth factor combined with sodium hyaluronate eye drops in patients with cataract after multifocal intraocular lens implantation / 中国基层医药

Objective:To investigate the clinical efficacy of recombinant human epidermal growth factor combined with sodium hyaluronate eye drops in the treatment of cataracts after multifocal intraocular lens implantation and its effect on inflammation factors in tears and tear film stability.Methods:A total of 86 patients with cataracts who underwent multifocal intraocular lens implantation at Jinan 2 nd People's Hospital from July 2020 to January 2023 were included in this randomized controlled study. These patients were randomly divided into a control group and a combined group, with 43 patients in each group. Patients in the control group were administered sodium hyaluronate eye drops postoperatively, while patients in the combined group received a combination of recombinant human epidermal growth factor and sodium hyaluronate eye drops. All patients were treated for 1 month. Before and after treatment, the levels of inflammatory factors in tears, tear film stability-related indicators, and corneal endothelial cells were measured and compared between the two groups. Additionally, any adverse reactions experienced by the patients were recorded throughout the treatment period. Results:After treatment, the levels of interleukin-6 and tumor necrosis factor-α in the tear fluid of the combined group were (17.91 ± 2.45) μg/L and (72.14 ± 8.43) μg/L, respectively. These values were significantly lower than those in the control group, which were (24.63 ± 3.05) μg/L and (86.97 ± 9.85) μg/L, respectively ( t = 11.26, 7.50, both P < 0.001). Additionally, the fluorescein staining score for corneal damage in the combined group was (2.34 ± 0.37) points. This was significantly lower than the score of (3.42 ± 0.48) points observed in the control group ( t = 11.69, P < 0.001). Tear break-up time and Schirmer I Test in the combined group were (8.68 ± 0.96) seconds and (9.31 ± 1.04) mm/5 minutes, respectively. These values were significantly higher than those in the control group, which were (7.81 ± 0.89) seconds and (7.14 ± 0.86) mm/5 minutes, respectively ( t = -4.36, -10.54, both P < 0.001). Furthermore, the corneal endothelial cell density and the proportion of hexagonal cells in the combined group were (2 514.09 ± 259.31) counts/mm 2 and (41.67 ± 5.05)%, respectively. These values were significantly higher than those in the control group, which were (2 244.82 ± 253.37) counts/mm 2 and (36.75 ± 4.96)% in the control group ( t = -4.87, -29.45, both P < 0.001). The incidence of adverse reactions in the combined group was 11.63% (5/43), which was significantly higher than 6.98% (3/43) in the control group ( χ2 = 0.55, P > 0.05). Conclusion:The combination of recombinant human epidermal growth factor with sodium hyaluronate eye drops following multifocal intraocular lens implantation in patients with cataracts effectively decreases the levels of inflammatory factors in tear fluid. This treatment regimen also enhances tear film stability, promotes the repair of injured corneal tissue, and is highly safe.

Prognostic value of a classification and regression tree model in patients with open-globe injuries

Objective@#To evaluate the accuracy of the Classification and Regression Tree (CART) model in prognosticating visual outcomes of patients with open-globe injuries@*Methods@#This was a retrospective, single-center, cohort study of patients with open-globe injuries seen over a two-year period. Purposive sampling of hospital medical records was done to collect data from both in- and out-patient cases. The CART algorithm was utilized to determine the predicted visual outcome for each case, and the accuracy of prognostication was measured by computing for sensitivity, specificity, positive predictive value, and negative predictive value. The area under the receiver operating characteristic curve was used to check its discriminatory capability.@*Results@#A total of 65 eyes (65 patients) with the following diagnoses based on the Birmingham Eye Trauma Terminology (BETT) classification were included: penetrating eye injury (n=58), globe rupture (n=2), and intraocular foreign body (n=5). Majority were male patients (81.5%) in the 17-39 year age group (40%). The sensitivity and specificity of CART were 100% (95% CI 93.6 to 100%) and 77.8% (95% CI 40 to 97.2%), respectively, with an overall accuracy of 96.9% (95% CI 89.3 to 99.6%). Area under the curve (AUC) was statistically significant at 0.89 (95% CI 0.79 to 0.95), indicating that the CART model can discriminate vision survival versus no vision.@*Conclusion@#The CART model demonstrated high accuracy in prognosticating visual outcomes after an openglobe injury in the local setting. It may be used as a helpful tool to guide treatment decisions in open-globe injuries.

Accuracy comparison of different formulas in calculating intraocular lens power in cataract patients after corneal refractive surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare and observe the accuracy of five intraocular lens(IOL)power calculation formulas in patients with cataracts who have previously undergone corneal refractive surgery.METHODS: Prospective case series study. A total of 23 cataract patients(34 eyes)with a history of myopic corneal refractive surgery at Jinan Mingshui Eye Hospital from September 2021 to March 2023 were collected, including 1 eye treated with photorefractive keratectomy(PRK)and 22 patients(33 eyes)treated with laser-assisted in situ keratomileusis(LASIK). Preoperative ocular biometry was performed using the IOL Master 700, while corneal true net refractive power(TNP)was measured via Pentacam analyzer. Anterior segment optical coherence tomography(OCT)was used to assesse net corneal power(NCP), posterior corneal refractive power, and central corneal thickness(CCT). The Shammas, Haigis-L, Potvin-Hill Pentacam, OCT, and Barrett True K formulas were utilized for IOL power calculations, with the optimal power selected accordingly. At 1 mo postoperatively, actual refractive outcomes were determined through subjective refraction, based on objective optometry results. The refractive prediction error(RPE)and refractive absolute error(RAE)of each formula were calculated and compared, and the percentage of eyes with RAE ≤0.5 D and ≤1.0 D was counted.RESULTS: No significant statistical difference was found in the RPE of the five formulas when compared to zero(all P&#x003E;0.05), nor were there significant differences in RPE and RAE among the formulas(F=0.554, P=0.696; H=4.402, P=0.354). The RAE was within ≤0.5 D for 26 eyes(76%)using the Potvin-Hill Pentacam formula and for 24 eyes(71%)using the Barrett True K formula, with both formulas achieving an RAE within ≤1.0D in 33 eyes(97%).CONCLUSIONS: The Barrett True K and Potvin-Hill Pentacam formulas demonstrated high predictive accuracy for IOL power calculations in post-corneal refractive surgery cataract patients. Given the variability in corneal refractive power among these patients, further research on IOL power calculation is warranted. Clinically, it is advisable to consider a range of formulas for optimal outcomes.

Preliminary observation of PAUL glaucoma implant in glaucoma treatment / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To preliminarily assess the efficacy and safety of PAUL glaucoma implant in glaucoma management.METHODS: Clinical data of 10 glaucoma patients(10 eyes)who treated with Paul's glaucoma implant from March 2022 to January 2023 were retrospectively analyzed. A follow-up of 12 mo was performed to observe changes in visual acuity, intraocular pressure, and number of anti-glaucoma medications before and after surgery.RESULTS: Included patients had no significant change in visual acuity from preoperative to last follow-up; preoperative intraocular pressure was 19-60(median 28)mmHg, and it was 10-18(median 14)mmHg at last follow-up. All patients required two to four antiglaucoma medications preoperatively, and only 1 case needed medications at final follow-up. Four patients had a significant decrease in corneal endothelial cell density compared with the preoperative period, and no corneal-related complications occurred. At final follow-up, all 10 patients met surgical success criteria.CONCLUSION: PAUL glaucoma implant has significant IOP lowering efficacy and that corneal endothelial cell damage may be a pitfall of its presence.

Diopter errors and safety of secondary intraocular lens implantation in the ciliary sulcus using a modified incision procedure in children with bilateral aphakia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the diopter errors and safety of secondary intraocular lens(IOL)implantation in the ciliary sulcus using a modified incision procedure in children with bilateral aphakia.METHODS: The data of 12 children(24 eyes)with bilateral aphakia who had undergone secondary foldable IOL implantation in the ciliary sulcus using a modified incision procedure from 2020 to 2021 were retrospectively reviewed. Incision-related complications were analyzed intraoperatively and at 1 d and 1 mo postoperatively. Best-corrected visual acuity(BCVA), axial length(AL), white-to-white(WTW), and refractive outcomes in terms of preoperative reserved diopters(PRD)and actual equivalent spherical diopters(AESD). The patients were divided into two groups by age(≤7 and &#x003E;7 a), AL(&#x003C;23 and ≥23 mm)and WTW(≤11.5 and &#x003E;11.5mm), and the diopter errors between their AESD and PRD predicted based on the measurement results were compared.RESULTS: The patients comprised 9(75%)boys and 3(25%)girls. Two(17%)patients had anterior subcapsular cataracts, 4(33%)had posterior polar cataracts, and 6(50%)had nuclear cataracts. The mean age at cataract extraction was 6.4±1.61(3.4-8.9)mo. The mean interval between cataract extraction and secondary IOL implantation was 6.8±1.82(4.4-11.5)a. The mean preoperative BCVA was 0.49±0.33(1.0-0.1)LogMAR. The mean postoperative BCVA was 0.38±0.32(1.0-0.0)LogMAR. The mean AL was 23.56±1.96(19.00-26.38)mm, and the mean WTW was 11.5±0.92(9.3-13.9)mm. The mean PRD was 1.57±0.60(0.73-2.77)D, the mean AESD was 0.57±0.55(-0.50 to 1.75)D, and the mean difference between the AESD and PRD was -0.99±0.52(-2.22 to 0.32)D. The differences in the AESD and PRD between the groups according to age, AL and WTW were not statistically significant(P=0.59, 0.56, and 0.53, respectively).CONCLUSION: IOL implantation in the ciliary sulcus after a modified incision is safe and feasible for children with aphakia. It is necessary to subtract approximately 1 D of IOL power from the formula-selected power when implanting an IOL in the ciliary sulcus. Age, AL, and WTW do not significantly affect the difference.