[Visual quality comparison after multifocal toric intraocular lens or monofocal toric intraocular lens implantation].

Objective: To compare visual quality and satisfaction after multifocal toric intraocular lens (Acrysof IQ Restor toric, ART) and monofocal toric intraocular lens implantation in patients. Methods: It was a prospective nonrandomized Phase Ⅲ clinical trial. Patients with age-related cataract and corneal astigmatism were enrolled and accepted phacoemulsification combined with implantation of intraocular lens (IOL) in Henan Provincial Eye Hospital during March 2013 to December 2014. Fifty-six cases were divided into two groups according to which IOL they chose. ART group included 28 cases (3l eyes) aged from 41.0 to 72.0 years, with an average age of 61.5 years; toric group included 28 cases (33 eyes) aged from 42.0 to 75.0 years, with an average age of 63.5 years. Three months postoperatively, uncorrected distance visual acuity (UDVA) at 5, 70, 40 cm, corrected distance, intermediate, and near visual acuities, defocus curve, residual refractive astigmatism, rotational stability of the IOL, contrast sensitivity and patientsatisfaction were evaluated. All data were processed by statistic package deal SPSS 16.0. Postoperative visual acuity, residual astigmatism, IOL axial rotation and contrast sensitivity were compared by independent samples t test; preoperative and postoperative corneal astigmatism were compared by paired t-test; spectacle independency and halo incidence were processed by χ(2) test; visual satisfaction score was analyzed by Mann-Whitney test. Results: At 3 months postoperatively, in ART group, UDVA was (0.04±0.05), UIVA was (0.24±0.15), UNVA was (0.20±0.24). While in Toric group, UDVA was (0.06±0.04), UIVA was (0.30±0.13), UNVA was (0.47±0.21). There was no significant difference in UDVA between two groups(t=0.79, P=0.433). But in ART group, UIVA and UNVA were markedly better than those in Toric group(t=2.74, P=0.008; t=3.45, P<0.01). Depth of focus was 5.50 D (+2.00--3.50 D) in the ART group and 2.50 D (+1.00--1.50 D) in the Toric group. Average postoperative residual astigmatism was (-0.45±0.41)D in ART group and (-0.41±0.32)D in the Toric group. There was no significant difference between two groups (t=1.05, P=0.304). Average IOL rotation test was (2.95°±1.34°) in the ART group and (2.75°±1.64°) in the Toric group. There was no significant difference between two groups (t=0.67, P=0.452). Spectacle independency was achieved by 85.7% of patients in the ART group and 32.1% in the Toric group. There was no signifcant difference in distant visual satisfaction scores between the two groups(Z=0.71, P>0.05), while the intermediate and near visual satisfaction scores were significantly different(Z=2.27, P<0.05; Z=2.60, P<0.05) Conclusions: Both of the ART IOL and toric IOL can correct patients astigmatism. Implantation of ART IOL in patients with cataract and corneal astigmatism provided excellent distance, intermediate, and near visual outcomes. It provided better predictability of the refractive results, nice rotational stability, and good optical performance. At the same time, it improved the spectacle independency of cataract patients with astigmatism. (Chin J Ophthalmol, 2017, 53: 274-280).

Epigenetic changes of the Klotho gene in age-related cataracts.

OBJECTIVE: To determine the mRNA and protein expression, and methylation levels of the Klotho in lens epithelial cells (LECs) of normal transparent lenses and age-related cataracts (ARCs), and to explore the role of epigenetic changes of the Klotho gene in regulating the development of ARCs. PATIENTS AND METHODS: A total of 90 subjects were divided into three groups: a young adult group with normal transparent lenses aging from18 to30 years, a middle-aged group with ARC aging from 40 to 49 years, and an elderly group with ARC aging from 67 to 85 years. The LECs were collected through curvilinear capsulorhexis. The mRNA expression of the Klotho gene was determined using the reverse transcription polymerase chain reaction (RT-PCR). Protein expression of the Klotho gene in LECs was detected using immunohistochemical (IHC) staining. The methylation specific polymerase chain reaction (MSP) was used to detect the methylation level of the target gene. RESULTS: Decreased mRNA expression of the Klotho gene was reversely correlated with age. IHC results showed that the Klotho was mainly expressed in the cell membrane and cytoplasm of LECs. It was strongly positive in the young adult group (100.0%), with even distribution; weakly positive in the middle-aged group (36.7%), with expression distributed 4-5 mm away from the center of the anterior lens capsule; and negative in the elderly group (0.0%). MSP results showed that the Klotho gene was highly methylated in the elderly group (93.3%) and weakly methylated (56.7%) in the middle-aged group, but barely methylated in the young adult group (3.3%). CONCLUSIONS: Klotho were positively expressed in the LECs of normal individuals at the mRNA and protein level. Its promoter showed increased methylation as age increased, resulting in Klotho gene silencing as well as down-regulated expression or no expression of the Klotho protein. These epigenetic changes could affect the biological activities of LECs, which provided the basis for further studies of the association between the Klotho gene and ARC.