Effects of atropine eyedrops at ten different concentrations for myopia control in children: A systematic review on meta-analysis.

PURPOSE: To estimate the effect of atropine eyedrops at different concentrations for myopia control in children. METHODS: We conducted a Bayesian random-effects network meta-analysis based on randomized controlled trials (RCT). Primary outcomes include changes in spherical equivalent error (SER) and changes in axial length (AL), mean difference (MD) together with 95% credible interval (CrI) were used to evaluate the efficacy. RESULTS: 28 RCTs (6608 children) were included in this review. Comparing ten atropine eyedrops (0.0025%, 0.005%, 0.01%, 0.02%, 0.025%, 0.05%, 0.1%, 0.25%, 0.5% and 1% concentrations) with the placebo, the MDs and 95%CrIs of changes in SER are -0.006 (-0.269, 0.256) D, 0.216 (-0.078, 0.508) D, 0.146 (0.094, 0.199) D, 0.167 (0.039, 0.297) D, 0.201 (0.064, 0.341) D, 0.344 (0.251, 0.440) D, 0.255 (0.114, 0.396) D, 0.296 (0.140, 0.452) D, 0.331 (0.215, 0.447) D, and 0.286 (0.195, 0.337) D, respectively. The MDs and 95%CrIs of changes in AL are -0.048 (-0.182, 0.085) mm, -0.078 (-0.222, 0.066) mm, -0.095 (-0.130, -0.060) mm, -0.096 (-0.183, -0.009) mm, -0.083 (-0.164, -0.004) mm, -0.114 (-0.176, -0.056) mm, -0.134 (-0.198, -0.032) mm, -0.174 (-0.315, -0.061) mm, -0.184 (-0.291, -0.073) mm, and -0.171 (-0.203, -0.097) mm, respectively.Whether evaluated by SER or AL, 1% concentration ranks first in efficacy, but the risk of photophobia is 17 times higher than 0.01% concentration. CONCLUSIONS: 0.01% or higher concentration atropine eyedrops are effective for myopia control, while 0.0025% and 0.005% concentrations may not. As the concentration increases, the effect tends to increase, 1% concentration may have the strongest effect.

An auxiliary diagnostic tool for common fundus diseases based on fundus color photography and light-weight classification models.

OBJECTIVE: To evaluate the performance of two lightweight neural network models in the diagnosis of common fundus diseases and make comparison to another two classical models. METHODS: A total of 16,000 color fundus photography were collected, including 2000 each of glaucoma, diabetic retinopathy (DR), high myopia, central retinal vein occlusion (CRVO), age-related macular degeneration (AMD), optic neuropathy, and central serous chorioretinopathy (CSC), in addition to 2000 normal fundus. Fundus photography was obtained from patients or physical examiners who visited the Ophthalmology Department of Beijing Tongren Hospital, Capital Medical University. Each fundus photography has been diagnosed and labeled by two professional ophthalmologists. Two classical classification models (ResNet152 and DenseNet121), and two lightweight classification models (MobileNetV3 and ShufflenetV2), were trained. Area under the curve (AUC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were used to evaluate the performance of the four models. RESULTS: Compared with the classical classification model, the total size and number of parameters of the two lightweight classification models were significantly reduced, and the classification speed was sharply improved. Compared with the DenseNet121 model, the ShufflenetV2 model took 50.7% less time to make a diagnosis on a fundus photography. The classical models performed better than lightweight classification models, and Densenet121 showed highest AUC in five out of the seven common fundus diseases. However, the performance of lightweight classification models is satisfying. The AUCs using MobileNetV3 model to diagnose AMD, diabetic retinopathy, glaucoma, CRVO, high myopia, optic atrophy, and CSC were 0.805, 0.892, 0.866, 0.812, 0.887, 0.868, and 0.803, respectively. For ShufflenetV2model, the AUCs for the above seven diseases were 0.856, 0.893, 0.855, 0.884, 0.891, 0.867, and 0.844, respectively. CONCLUSION: The training of light-weight neural network models based on color fundus photography for the diagnosis of common fundus diseases is not only fast but also has a significant reduction in storage size and parameter number compared with the classical classification model, and can achieve satisfactory accuracy.

Six-month repeated irradiation of 650 nm low-level red light reduces the risk of myopia in children: a randomized controlled trial.

PURPOSE: To evaluate whether the six-month repeated irradiation of 650 nm low-level red light (LLRL) decreases the risk of myopia onset in children. METHODS: This was a single-masked, randomized controlled trial. A total of 112 children (aged 6-12 years) were enrolled and randomized to the treatment group or control group in a 1:1 ratio. The cycloplegic spherical equivalent error (SER) of children at baseline was -0.5 diopter (D) to 3D. Children in the treatment group were irradiated with the 650 nm LLRL for 6 min daily. No intervention was given to the control. The primary outcomes are myopia incidence, change in cycloplegic SER, and change in axial length (AL). RESULTS: For the treatment group and control group, the six-month myopia incidence rates were 1.8% (95% confidence interval, CI: 0.2-4.9%) and 12.5% (95% CI: 5.5-21.9%), respectively. The difference was significant (p = 0.028). The median changes in AL for the treatment group and control group were -0.02 (interquartile range, IQR: -0.12 to 0.06) mm, and 0.09 (IQR: 0-0.18) mm, respectively. The difference was significant (p < 0.001). The median changes in cycloplegic SER for the treatment group and control group were 0 (IQR: 0-0.25) D, and -0.125 (IQR: -0.375 to 0) D, respectively. The difference was significant (p < 0.001). There was no adverse event. CONCLUSION: The repeated irradiation of 650 nm LLRL may have a strong effect for myopia prevention in children, without risk of adverse events. TRIAL REGISTRATION: this trial is retrospectively registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ), the registration number is ChiCTR2200058963.

Normal thyroid stimulating hormone is associated with all-cause mortality in patients with acute myocardial infarction after percutaneous coronary intervention.

BACKGROUND: Circulating thyroid-stimulating hormone (TSH) levels within the normal reference range can affect the cardiovascular system. The present study investigated the prognostic value of normal TSH levels in patients presenting with acute myocardial infarction (AMI) following percutaneous coronary intervention (PCI). METHODS: Between January 2013 and July 2019, 1240 patients with AMI and normal thyroid function were enrolled and classified according to TSH tertile. The trial endpoint was all-cause mortality. The integrated discrimination index (IDI) and the net reclassification index (NRI) were used to assess the combined predictive values of the TSH levels and the Global Registry of Acute Coronary Events (GRACE) scores. RESULTS: After a median 44.25-month follow-up, 195 individuals died. Even after covariate adjustment by multivariate Cox regression (HR: 1.56; 95% CI 1.08-2.25; P = 0.017), the patients in the third TSH tertile were at the highest risk of all-cause mortality. A subgroup analysis revealed significant interactions between the TSH levels and the GRACE scores (high risk vs. low/medium risk) (P = 0.019). The addition of the TSH levels to the GRACE scores substantially improved the prediction of all-cause mortality, especially for high-risk patients (NRI = 0.239; IDI = 0.044; C-statistic value range 0.649-0.691; all significant). CONCLUSIONS: The third TSH tertile is associated with a higher incidence of all-cause mortality than the first TSH tertile in high-risk patients presenting with AMI after PCI.

Association between dosing of spironolactone and outcomes in heart failure with preserved ejection fraction patients combined with chronic kidney disease------Balance of efficacy and risk.

Aims: Few studies have compared the association between dosing of spironolactone and outcomes in patients with heart failure with preserved ejection fraction (HFpEF), and whether spironolactone dose could significantly affect the prognosis of HFpEF patients combined with chronic kidney disease (CKD) remains unclear. Our aim was to directly compare 'high vs. low' doses of spironolactone in an attempt to find a benefit-risk-balanced point, and infer an adequate dose for HFpEF with CKD patients. Methods: Overall, 4,321 symptomatic heart failure inpatients were initially screened from January 2013 to December 2019, and all enrolled patients were followed-up for 36 months; After including patients who meet the diagnostic criteria of HFpEF and CKD with ejection fraction > 45% and estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, a total of 387 patients was selected. Primary outcome was a composite of all-cause death, heart failure (HF) hospitalization and non-fatal stroke. The key safety outcome was hyperkalemia rates during the follow-up period. Results: The primary outcome event rates in patients with or without spironolactone were 12.74 and 21.45 per 100 person-years, respectively. Compared with patients not taking spironolactone, the adjusted hazard ratio (HR) [95% confidence interval (CI)] was 0.55 (0.38-0.79) with spironolactone group for primary outcomes. After grouped by the daily dose of spironolactone, low-dose group (≤ 40 mg) was associated with lower relative risk for the primary efficacy outcome [adjusted HR (95% CI) was 0.43 (0.23-0.81), 0.50 (0.33-0.76) and 0.74 (0.36-2.79) with < 40 mg, 40 mg and >40 mg, respectively]. During 3-year follow-up, the risk for hyperkalemia was amplified in the higher dose group (>40 mg) while showed no significant difference compared with low dose group (p = 0.425). Conclusion: HFpEF with CKD patients using spironolactone had lower risk of adverse cardiovascular outcomes. And the use of low-dose spironolactone (≤ 40 mg) showed the best efficacy and safety, therefore we may recommend ≤ 40 mg as the optimal initial dose for these patients. However, this was a relatively small sample size, retrospective study, and further adequately powered randomized trials are needed to verify these results.

Investigation of the Efficacy and Safety of 650 nm Low-Level Red Light for Myopia Control in Children: A Randomized Controlled Trial.

INTRODUCTION: To evaluate the 6-month efficacy and safety of 650 nm low-level red light (LLRL) for myopia control in children. METHODS: This was a single-center, single-masked randomized controlled trial. A total of 224 children aged 6-12 years with spherical equivalent error (SER) of - 6 diopter (D) to - 0.5 D were enrolled, and were randomized to LLRL group or control group. Children in the LLRL group underwent treatment twice daily, each lasting for 3 min, there was an interval of at least 4 h between treatments. Children in both groups were allowed to wear single-vision spectacles; no additional intervention was given to the control. The primary outcomes included change in cycloplegic SER and change in axial length (AL) during 6 months. RESULTS: The median 6-month changes in AL of the LLRL and control groups were - 0.06 mm (interquartile range, IQR - 0.15, 0) and 0.14 mm (IQR 0.07, 0.22), respectively. The difference between groups was significant (Z = 10.021, p < 0.001). The median 6-month changes in SER were 0.125 D (IQR 0, 0.375) and - 0.25 D (IQR - 0.5, 0) for the LLRL and control groups, respectively. The difference between groups was significant (Z = 8.827, p < 0.001). Compared with the control, the proportion of children with hyperopic shift in the LLRL group was higher (51.65% vs. 3.41%, p < 0.001), and the proportion of children with shortened AL in the LLRL group was higher (63.74% vs. 2.27%, p < 0.001). No adverse event was observed. CONCLUSION: 650 nm LLRL significantly slowed down the myopia progression in children aged 6-12 years, and there was no observable side effect in the short term.

[Curcumin improves cardiac fibrosis by inhibiting endothelial-mesenchymal transition through NRF2-DDAH-ADMA-NO pathway].

The present study analyzed the correlations between curcumin(Cur), nuclear factor E2 related factor 2(NRF2)-dimethylarginine dimethylaminohydrolase(DDAH)-asymmetric dimethylarginine(ADMA)-nitric oxide(NO) pathway, and endothelial-mesenchymal transition(EndMT) based on SD rats with cardiac fibrosis, and explored the effect and mechanism of Cur in resisting cardiac fibrosis to provide an in-depth theoretical basis for its clinical application in the treatment of heart failure. The cardiac fibrosis model was induced by subcutaneous injection of isoprenaline(Iso) in rats. Thirty-two rats were randomly divided into a control group, a model group, a low-dose Cur group(100 mg·kg~(-1)·d~(-1)), and a high-dose Cur group(200 mg·kg~(-1)·d~(-1)), with eight in each group. After 21 days of treatment, cardiac function was detected by echocardiography, degree of cardiac fibrosis by Masson staining, expression of CD31 and α-SMA by pathological staining, expression of VE-cadherin, vimentin, NRF2, and DDAH by Western blot, and ADMA level by HPLC. Compared with the model group, the Cur groups showed alleviated cardiac fibrosis, accompanied by increased CD31 and VE-cadherin expression and decreased α-SMA and vimentin expression, indicating relieved EndMT. Additionally, DDAH and NRF2 levels were elevated and ADMA and NO expression declined. Cur improves cardiac fibrosis by inhibiting EndMT presumedly through the NRF2-DDAH-ADMA-NO pathway.

Clinical Impact of Thrombus Aspiration and Interaction With D-Dimer Levels in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Objectives: To evaluate the effect of thrombus aspiration (TA) strategy on the outcomes and its interaction with D-dimer levels in patients with ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) in "real-world" settings. Materials and Methods: This study included 1,295 patients with STEMI who had undergone primary PCI with or without TA between January 2013 and June 2017. Patients were first divided into a TA+PCI group and a PCI-only group, and the baseline characteristics and long-term mortality between the two groups were analyzed. Furthermore, we studied the effect of TA on the clinical outcomes of patients grouped according to quartiles of respective D-dimer levels. The primary outcome was all-cause mortality, and the secondary outcomes were new-onset heart failure (HF), rehospitalization, re-PCI, and stroke. Results: In the original cohort, there were no significant differences in all-cause mortality between the TA+PCI and PCI-only groups (hazard ratio, 0.789; 95% confidence interval, 0.556-1.120; p = 0.185). After a mean follow-up of 2.5 years, the all-cause mortality rates of patients in the TA + PCI and PCI-only groups were 8.5 and 16.2%, respectively. Additionally, differences between the two groups in terms of the risk of HF, re-PCI, rehospitalization, and stroke were non-significant. However, after dividing into quartiles, as the D-dimer levels increased, the all-cause mortality rate in the PCI group gradually increased (4.3 vs. 6.0 vs. 7.0 vs. 14.7%, p < 0.001), while the death rate in the TA+PCI group did not significantly differ (4.6 vs. 5.0 vs. 4.0 vs. 3.75%, p = 0.85). Besides, in the quartile 3 (Q3) and quartile 4 (Q4) groups, the PCI-only group was associated with a higher risk of all-cause mortality than that of the TA+PCI group (Q3: 4.0 vs. 7.0%, p = 0.029; Q4: 3.75 vs. 14.7%, p < 0.001). Moreover, the multivariate logistic regression analysis demonstrated that TA is inversely associated with the primary outcome in the Q4 group [odds ratio (OR), 0.395; 95% CI, 0.164-0.949; p = 0.038]. Conclusions: The findings of our real-world study express that routine manual TA during PCI in STEMI did not improve clinical outcomes overall. However, patients with STEMI with a higher concentration of D-dimer might benefit from the use of TA during primary PCI. Large-scale studies are recommended to confirm the efficacy of TA.

Effect of lens capsular tension ring on preventing capsular contraction syndrome in the surgery of retinitis pigmentosa combined with cataract: Retrospective case series.

PURPOSE: To observe the effect of phacoemulsification and intraocular lens (IOL) implantation with or without lens capsular tension ring (CTR) on retinitis pigmentosa (RP) combined with cataract patients. DESIGN: Retrospective cases series study. METHODS: Sixty-three cases (84 eyes) of RP with cataract were collected, including 30 males and 33 females. Phacoemulsification with 3.0 mm clear corneal incision was performed in all the patients. IOL and CTR implantation were performed in 44 eyes, and IOL implantation alone was performed in 40 eyes. All cases were followed up at 1 day, 1 week and 1, 3, 6,12 months after the surgery to compare the best-corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell count (ECC) and complications before and after the surgery. RESULTS: All surgery were successfully completed by the same physician, and IOL and CTR were all implanted in capsule without complications. The BCVA at 6 months after surgery was 0.91 ± 0.88 LogMAR, showing an improvement compared with the BCVA(1.3 ± 0.7LogMAR) before surgery and there was a statistically significant difference (P = .003). Four cases of capsule contraction syndrome (CCS) occurred in no CTR implantation group and there was no CCS in CTR group. There was a statistically significant difference in the incidence of CCS between two groups (P = .047). CONCLUSIONS: Phacoemulsification for RP combined with cataract is safe and reliable, and CTR implantation is conducive to reducing the complications caused by capsule contraction.

Diagnostic Value of Optical Coherence Tomography Angiography for Choroidal Neovascularization in Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis.

OBJECTIVE: This study aims to evaluate the diagnostic value of optical coherence tomography angiography (OCTA) in detecting the choroidal neovascularization (CNV) in age-related macular degeneration (AMD). METHODS: A systematic review and meta-analysis was performed by searching Pubmed, Science Direct, Embase, and Web of Science. The pooled sensitivity and specificity with 95% confidence intervals (CIs), area under the summary receiver operator characteristic curve (sROC), and the total accurate classification rate were used to evaluate OCTA's diagnostic value of CNV in AMD patients. RESULTS: Seven studies involving 517 eyes were included in the analysis. The mean age of subjects in each study ranged from 58.5 years to 81.7 years. Fluorescein angiography was applied as the gold standard in 5 studies. There were 350 eyes diagnosed with CNV, OCTA detected 301 eyes correctly, while among the 167 eyes without CNV, OCTA identified 150 correctly. The total accurate classification rate was 87.23%. The Spearman's rank correlation coefficient was 0.5, indicating that there was no significant threshold effect in the current study (S = 8, p = 0.103). The pooled sensitivity and pooled specificity were 0.89 (95% CI: 0.82, 0.94) and 0.96 (95% CI: 0.85, 1.00), respectively. The area under sROC was up to 0.911. CONCLUSION: The specificity of OCTA for the detection of CNV in AMD patients is extremely high; however, the sensitivity still needs to be improved. In general, the meta-analysis revealed that OCTA had a high diagnostic value for the detection of CNV in AMD patients.

Horizontal and vertical optic disc rotation. The Beijing Eye Study.

PURPOSE: To measure the optic disc rotation around the vertical and horizontal disc axis and to evaluate associations with general and ocular parameters. DESIGN: Population-based study. METHODS: In the Beijing Eye Study, 3468 participants (mean age:64.6±9.8 years; range:50-93 years) underwent an ophthalmological examination which included spectral-domain optical coherence tomography (OCT) with enhanced depth imaging. Using the OCT images, we determined the amount of the rotation of the optic disc (defined as Bruch´s membrane opening (BMO)) around the vertical axis and horizontal axis. RESULTS: Optic disc rotation measurements were available for 3037 (87.6%) individuals. In multivariate analysis, larger optic disc rotation around the vertical axis (range:-4.90° to 41.0°) was associated (regression coefficient r:0.27) with high axial myopia (axial length ≥26.5 mm) (P<0.001;standardized regression coefficient beta beta:0.09), longer disc-fovea distance (P = 0.001;beta:0.09) and wider parapapillary beta/gamma zone (P<0.001;beta0.12). Larger optic disc rotation around the horizontal axis (range:-7.10° to 26.4°) was associated (r:0.32) with high axial myopia (P = 0.001;beta:0.08), larger optic disc-fovea angle (P<0.001;beta:0.13), thinner superior nasal retinal nerve fiber layer (RNFL) thickness (P<0.001;beta:-0.19) and thicker inferior nasal RNFL thickness (P<0.001;beta:0.17). CONCLUSIONS: Vertical optic disc rotation was associated with highly myopic axial elongation, increased disc-fovea distance and development or enlargement of parapapillary, Bruch´s membrane free, gamma zone, while macular Bruch´s membrane length is not affected. Horizontal optic disc rotation was associated with inferior dislocation of the fovea, in addition to a thinner superior nasal RNFL and thicker inferior nasal RNFL. The latter association may be taken into account in the interpretation of RNFL thickness profiles.

Possible association between Helicobacter pylori infection and nonalcoholic fatty liver disease.

Possible association between Helicobacter pylori infection (HPI) and nonalcoholic fatty liver disease (NAFLD) has been proposed by several studies with inconsistent conclusions. Here, we studied the association between HPI and NAFLD at 3 levels: (i) genetic level; (ii) small molecular level; and (iii) clinical level. Relation data between diseases, genes, and small molecules were acquired from Pathway Studio ResNet Mammalian database. Clinical data were acquired from 2263 elderly South Chinese subjects, including 603 NAFLD patients and 1660 subjects without NAFLD. Results showed that HPI and NAFLD present significantly shared genetic bases (95 genes, p value = 2.5E-72), demonstrating multiple common genetic pathways (enrichment p value ≤ 4.38E-20 for the top 10 pathways). Genetic network analysis suggested that mutual regulation may exist between HPI and NAFLD through 21 out of 95 genes. Furthermore, 85 out of the 95 genes manifested strong interaction with 12 small molecules/drugs that demonstrate effectiveness in treating both diseases. Clinical results showed that HPI rate in the NAFLD group was significantly higher than that in the group without NAFLD (51.9% vs. 43.6%; p value = 4.9E-4). Multivariate logistic regression results supported the observations and suggested that HPI served as a risk factor for NAFLD in the experiment data studied (odds ratio: 1.387, p value = 0.018). Results from this study support the hypothesis that complex biological association may exist between HPI and NAFLD, which partially explains the significant clinical co-incidence in the elderly population of south China.

Association between choroidal thickness and anterior chamber segment in eyes with narrow or open-angle.

AIM: To investigate the relationship between choroidal thickness and anterior chamber segment in subjects with eyes with narrow or open-angle. METHODS: The subfoveal choroidal thickness was measured with enhanced depth-imaging optical coherence tomography and anterior chamber parameters were measured with ultrasound biomicroscopy in one eye of 23 subjects with open-angle eyes and 38 subjects with narrow-angle eyes. The mean age was 59.52±7.04y for narrow-angle subjects and 60.76±7.23y for open-angle subjects (P=0.514). Multivariate linear regression analysis was performed to assess the association between choroidal thickness and narrow-angle parameters. RESULTS: There were no differences in subfoveal choroidal thickness between open- and narrow-angle subjects (P=0.231). Anterior chamber parameters, including central anterior chamber depth, trabecular iris angle, iris thickness 500 µm from the scleral spur (IT500), and ciliary body thickness at 1 mm and 2 mm from the scleral spur (CBT1, CBT2) showed significant differences between the two groups (P<0.05). Subfoveal choroidal thickness showed negative correlation (ß=-0.496, P=0.016) only with anterior chamber depth in the open-angle group and with age (ß=-0.442, P=0.003) and IT500 (ß=-0.399, P=0.008) in the narrow-angle group. However, subfoveal choroidal thickness was not correlated with trabecular iris angle, anterior chamber depth, ciliary body thickness, or central corneal thickness in the narrow-angle group. CONCLUSION: Choroidal thickness does not differ in the two groups and has not correlated with anterior chamber parameters in narrow-angle subjects, suggesting a lack of relationship between choroidal thickness and primary angle-closure glaucoma.

Prevalence and associations of central serous chorioretinopathy in elderly Chinese. The Beijing Eye Study 2011.

PURPOSE: To determine the prevalence and associations of central serous chorioretinopathy (CSC) in elderly Chinese. METHODS: The population-based cross-sectional Beijing Eye Study 2011 included 3468 individuals (age: 64.6 ± 9.8 years; range: 50-93 years), who underwent enhanced depth imaging of spectral-domain optical coherence tomography (SD-OCT). CSC was defined as serous detachment of the retina in the macular region without signs of haemorrhages or signs of polypoidal choroidal vasculopathy, exudative age-related macular degeneration or other retinal vascular disorders, both on fundus photographs and on optical coherence tomography (OCT) images. RESULTS: Central serous chorioretinopathy was diagnosed in 10 eyes (prevalence rate: 0.15 ± 0.05%; 95% confidence interval (CI):0.06%, 0.25%) of 10 subjects (prevalence rate: 0.31 ± 0.10%; 95% CI: 0.12%, 0.50%). In five subjects, CSC was located foveally, and in five subjects, CSC was located extrafoveally. All subjects affected by foveal CSC were men, and three of the five individuals with extrafoveal CSC were men. In univariate analysis, subjects with CSC were significantly younger than the remaining study participants, and foveal CSC showed a significant (p = 0.02) predilection for men. After adjusting for age and gender, individuals with foveal CSC (383 ± 112 µm versus 270 ± 47 µm; p = 0.02) and the whole group of subjects with CSC had a significantly thicker subfoveal choroid. In a parallel manner, eyes contralateral to eyes with foveal CSC showed a significantly thicker subfoveal choroid than the age-adjusted control group (413 ± 74 µm versus 270 ± 47 µm; p = 0.001). CONCLUSIONS: In Chinese aged 50+ years, the prevalence of CSC was 0.14% per subject. The choroid in the CSC affected eyes and in the contralateral unaffected eyes was significantly thicker than in an age- and gender-adjusted control population-based group.

MACULAR BRUCH MEMBRANE DEFECTS IN HIGHLY MYOPIC EYES: The Beijing Eye Study.

PURPOSE: To examine prevalence and associations of macular Bruch membrane defects (MBMDs) in a population-based setting. DESIGN: Population-based cross-sectional study. METHODS: The Beijing Eye Study 2011 included 3,468 subjects who underwent a detailed ophthalmic examination including spectral domain optical coherence tomography with enhanced depth imaging of the macula. Macular Bruch membrane defects were defined as an interruption of Bruch membrane on the optical coherence tomography images in the macular region. RESULTS: Macular Bruch membrane defects could be detected only in highly myopic eyes (defined as refractive error of ≤-6 diopters or axial length of ≥26.5 mm) with a prevalence of 17/164 (10.4%, 95% confidence interval [CI], 5.7%-18.1%). Best-corrected visual acuity <0.05 was found in 5 (29%) of 17 eyes with MBMDs, and in 7 (41%) eyes, visual acuity was <0.3 and ≥0.05. In the MBMD region, retinal pigment epithelium and choriocapillaris were completely lost, and the deep and middle layers of the retina and the choroid were almost completely absent. In the MBMD region, mean retinal thickness was 153 ± 57 µm (mean ± SD) and choroidal thickness was 12.7 ± 28.1 µm. On the fundus photographs, MBMDs appeared as whitish areas with round borders. In multivariate regression analysis, presence of MBMD was significantly associated only with longer axial length (Odds ratio: 3.87; 95% CI, 1.64-9.14). CONCLUSION: Macular Bruch membrane defects with a prevalence of approximately 10% in highly myopic eyes are associated with a complete loss of retinal pigment epithelium and choriocapillaris, an almost complete loss of photoreceptors and choroid, and marked reduction in visual acuity. Macular Bruch membrane defects may be added to the panoply of features of myopic maculopathy.

Subfoveal choroidal thickness and cataract: the Beijing Eye Study 2011.

PURPOSE: This study examined subfoveal choroidal thickness (SFCT) in eyes with cataracts. METHODS: The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6 ± 9.8 years (range, 50-93 years of age). Enhanced depth imaging spectral domain optical coherence tomography was applied for measurement of SFCT. Using lens photographs, we graded cataracts by the Age-Related Eye Disease Study system. RESULTS: Assessments of SFCT and cataract were available for 2548 subjects. After adjusting for age, axial length, sex, anterior chamber depth, and lens thickness, we found that SFCT was not significantly associated with presence of nuclear cataract (P = 0.41). Conversely, the degree of nuclear cataract (P = 0.73) was not significantly associated with SFCT after adjusting for age and sex. In contrast, thicker SFCT was significantly associated with lower degree of posterior subcapsular cataract (P = 0.027; standardized regression coefficient ß: -0.04; regression coefficient B: -127; 95% confidence interval [CI]: -240 to -15) or with lower degree of cortical cataract (P = 0.028; ß:-0.06; B: -51.5; 95% CI: -97.3 to -5.59) after adjusting for younger age, shorter axial length, and deeper anterior chamber. Conversely, the degree of posterior subcapsular cataract (P = 0.027; ß:-0.06) or the degree of cortical cataract (P = 0.01; ß: -2.55) was associated with thinner SFCT in multivariate analysis. Correspondingly in binary regression analysis, presence of subcapsular cataract was associated with older age (P < 0.001; odds ratio (OR): 1.11; 95% CI: 1.09-1.14) and thinner SFCT (P = 0.006; OR: 0.997; 95% CI: 0.995-0.999). CONCLUSIONS: Although nuclear cataract was not significantly associated with an abnormal SFCT, the association between thin SFCT and subcapsular cataract or cortical cataract may have clinical importance, because thin SFCT is associated with low vision.

Visual acuity and subfoveal choroidal thickness: the Beijing Eye Study.

PURPOSE: To examine the association between best corrected visual acuity (BCVA) and subfoveal choroidal thickness. DESIGN: Population-based study. METHODS: The Beijing Eye Study 2011 included 3468 subjects with ages of 50+ years. The participants underwent an ophthalmologic examination including spectral-domain optical coherence tomography with enhanced depth imaging for measurement of choroidal thickness. BCVA was measured as logarithm of the minimal angle of resolution. RESULTS: Of the 3468 participants, choroidal measurements were available for 3233 (93.2%) subjects. In multivariate analysis, better BCVA was significantly associated with thicker subfoveal choroid (P < 0.001) in general and a subfoveal choroid thicker than 30 µm (P < 0.001) in particular, after adjusting for younger age (P < 0.001), higher level of education (P < 0.001), taller body stature (P < 0.001), higher body mass index (P = 0.005), absence of glaucoma (P = 0.001), absence of diabetic retinopathy (P < 0.001), absence of late-stage age-related macular degeneration (P < 0.001), and axial length shorter than 26.0 mm (P < 0.001) (correlation coefficient r:0.56). If eyes with glaucoma, diabetic retinopathy, late-stage age-related macular degeneration or myopic retinopathy were excluded, better BCVA was still significantly associated with thicker subfoveal choroid (P < 0.001) and subfoveal choroid thicker than 30 µm (P < 0.001) in multivariate analysis. In a reverse manner, thicker subfoveal choroid was associated with better BCVA (P < 0.001) after adjusting for younger age (P < 0.001), male gender (P < 0.001), longer axial length (P < 0.001), and higher corneal curvature radius (P < 0.001). CONCLUSIONS: Better visual acuity is strongly associated with thicker subfoveal choroid independent of additional factors, such as age, axial length, education level, and major ocular diseases.

Non-alcoholic fatty liver disease and risk of in-stent restenosis after bare metal stenting in native coronary arteries.

In-stent restenosis (ISR) remains the most common complication of percutaneous coronary intervention. Due to shared risk factors, it is postulated that non-alcoholic fatty liver disease (NAFLD) patients have an increased risk of ISR. This study aimed to determine the association between NAFLD and ISR in patients after bare metal stenting. This study included a cohort of 210 consecutive patients (150 men and 60 women) undergoing follow-up angiography. The primary end-point was angiographic ISR. Multivariate logistic regression analysis was used to identify independent risk factors for ISR. The cumulative ISR rate during follow-up was analyzed by Kaplan-Meier method. Subgroup analyses were also done for different gender. The ISR rate was 29.5%. Patients with NAFLD had a significantly higher prevalence of ISR than patients without NAFLD (43.3 vs. 16.0%, P < 0.001). In logistic regression analysis, NAFLD was associated with increased ISR, independent of low-density lipoprotein cholesterol, body mass index (adjusted odds ratio: 2.688, 95% confidence intervals: 1.285-5.537, P < 0.001). Male NAFLD patients had a higher prevalence of ISR than patients without NAFLD (48.4 vs. 15.3%, P < 0.001), while the prevalence of ISR in female patients with and without NAFLD were comparable (7.7 vs. 17.0%, P = 0.404). Kaplan-Meier analysis showed a significant association between NAFLD and ISR in all patients (log-rank P = 0.008) and in male subgroup (log-rank P = 0.033), but not in female subgroup (log-rank P = 0.313). This preliminary study suggests that NAFLD could independently associate with a high prevalence of ISR, especially in male patients.

Myopic maculopathy imaged by optical coherence tomography: the beijing eye study.

PURPOSE: To examine the features of myopia-related optical coherence tomography (OCT) findings in a population-based setting. DESIGN: Population-based study. PARTICIPANTS: The Beijing Eye Study 2011 included 3468 subjects with an age of 50 years or more. METHODS: The participants underwent a detailed ophthalmic examination including OCT with enhanced depth imaging of the macula. MAIN OUTCOME MEASURES: Optical coherence tomography features of the macula in highly myopic eyes defined by a refractive error of -6 diopters or less or an axial length of 26.5 mm or more. RESULTS: Readable OCT images were available for 6530 eyes (94.5%) of 3278 participants. The most common change in the macula was maculoschisis (0.8±0.1%), followed by incomplete posterior vitreous detachment (0.7±0.1%), disruption of the photoreceptor inner segment/outer segment interface (0.6±0.1%), epiretinal membranes (0.6±0.1%), macular defects in Bruch's membrane (0.3±0.1%), clumping of the retinal pigment epithelium (0.2±0.1%), vitreofoveal adhesion (0.2±0.1%), and macular holes in 2 eyes (0.1±0.1%). Prevalence of any myopic maculopathy per eye was 112 of 6530, or 1.71±0.16% (95% confidence interval [CI], 1.40-2.03). After adjustment for longer axial length (P<0.001; odds ratio [OR], 2.68; 95% CI, 1.97-3.64) and myopic refractive error (P<0.001; OR, 0.63; 95% CI, 0.55-0.73), presence of any myopic maculopathy was not significantly associated with any systemic variables (all P≥0.05), including biochemical blood examination and ocular parameters. Best-corrected visual acuity was associated significantly with the absence of a disruption of the photoreceptor inner segment/outer segment interface (P<0.001), epiretinal membranes (P<0.001), and macular holes (P<0.001) after adjustment for age and cylindrical refractive error. CONCLUSIONS: Based on OCT examination, the most common macular change in highly myopic eyes was maculoschisis, followed by incomplete posterior vitreous detachment, disruption of the photoreceptor inner segment/outer segment interface, epiretinal membranes, macular defects in Bruch's membrane, clumping of the retinal pigment epithelium, vitreofoveal adhesion, and macular holes. The most important macular changes with a negative effect on best-corrected visual acuity were a disruption of the photoreceptor inner segment/outer segment interface and epiretinal membranes.