A novel nomogram to predict glucocorticoid response in thyroid-associated ophthalmopathy: findings from a pilot study.

PURPOSE: Aimed to create a nomogram using clinical and eye-specific metrics to predict the efficacy of intravenous glucocorticoid (IVGC) therapy in patients with active and moderate-to-severe Thyroid-Associated Ophthalmopathy (TAO). METHODS: This study was conducted on 84 eyes from 42 moderate-to-severe TAO patients who received systemic IVGC therapy, and 42 eyes from 21 controls. Data were collected retrospectively from June 2020 to December 2021. The least absolute shrinkage and selection operator (LASSO) method was used to identify predictive factors for "unresponsiveness" to IVGC therapy. These factors were then analyzed using logistic regression to create a nomogram. The model's discriminative ability was robustly assessed using a Bootstrap resampling method with 1000 iterations for receiver operating characteristic (ROC) curve analysis. RESULTS: The LASSO analysis identified six factors with non-zero coefficients as significant, including Schirmer I test values, Meibomian gland (MG) diameter, MG length, disease duration, whole capillary vessel density (VD) in the radial peripapillary capillary (RPC), and whole macular VD for the superficial retinal capillary plexus (SRCP). The subsequent logistic regression model highlighted MG length, whole macular VD for SRCP, and disease duration as independent predictors of IVGC therapy response. The constructed nomogram demonstrated an area under the curve (AUC) of 0.82 (95% CI: 0.73-0.91), affirming the model's consistent and reliable ability to distinguish between responsive and non-responsive TAO patients. CONCLUSION: Our nomogram, combining MG length (<4.875 mm), SRCP VD (<50.25%), and disease duration (>5.5 months), reliably predicts lower IVGC therapy effectiveness in active, moderate-to-severe TAO patients.

0.01% Atropine Eye Drops in Children With Myopia and Intermittent Exotropia: The AMIXT Randomized Clinical Trial.

Importance: Exotropia and myopia are commonly coexistent. However, evidence is limited regarding atropine interventions for myopia control in children with myopia and intermittent exotropia (IXT). Objective: To evaluate the efficacy and safety of 0.01% atropine eye drops on myopia progression, exotropia conditions, and binocular vision in individuals with myopia and IXT. Design, Setting, and Participants: This placebo-controlled, double-masked, randomized clinical trial was conducted from December 2020 to September 2023. Children aged 6 to 12 years with basic-type IXT and myopia of -0.50 to -6.00 diopters (D) after cycloplegic refraction in both eyes were enrolled. Intervention: Participants were randomly assigned in a 2:1 ratio to 0.01% atropine or placebo eye drops administered in both eyes once at night for 12 months. Main Outcomes and Measures: The primary outcome was change in cycloplegic spherical equivalent from baseline at 1 year. Secondary outcomes included change in axial length (AL), accommodative amplitude (AA), exotropia conditions, and binocular vision at 1 year. Results: Among 323 screened participants, 300 children (mean [SD] age, 9.1 [1.6] years; 152 male [50.7%]) were included in this study. A total of 200 children (66.7%) were in the atropine group, and 100 (33.3%) were in the placebo group. At 1 year, the 0.01% atropine group had slower spherical equivalent progression (-0.51 D vs -0.75 D; difference = 0.24 D; 95% CI, 0.11-0.37 D; P < .001) and AL elongation (0.31 mm vs 0.42 mm; difference = -0.11 mm; 95% CI, -0.17 to -0.06 mm; P < .001) than the placebo group. The mean AA change was -3.06 D vs 0.12 D (difference = -3.18 D; 95% CI, -3.92 to -2.44 D; P < .001) in the atropine and placebo groups, respectively. The 0.01% atropine group had a decrease in near magnitude of exodeviation whereas the placebo group had an increase (-1.25 prism diopters [PD] vs 0.74 PD; difference = -1.99 PD; 95% CI, -3.79 to -0.19 PD; P = .03). In the atropine vs placebo group, respectively, the incidence of study drug-related photophobia was 6.0% (12 of 200 participants) vs 8.0% (8 of 100 participants; difference = -2.0%; 95% CI, -9.4% to 3.7%; P = .51) and for blurred near vision was 6.0% (12 of 200 participants) vs 7.0% (7 of 100 participants) (difference = -1.0%; 95% CI, -8.2% to 4.5%; P = .74). Conclusions and Relevance: The findings of this randomized clinical trial support use of 0.01% atropine eye drops, although compromising AA to some extent, for slowing myopia progression without interfering with exotropia conditions or binocular vision in children with myopia and IXT. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000039827.

Preoperative and Postoperative Clinical Factors in Predicting the Early Recurrence Risk of Intermittent Exotropia After Surgery.

PURPOSE: To identify preoperative and postoperative early recurrence risk in intermittent exotropia (IXT) patients after surgery. DESIGN: Prospective clinical cohort study. METHODS: We included 210 basic-type IXT patients who underwent either the bilateral rectus recession or unilateral recession and resection procedure and had complete follow-up until recurrence or for more than 24 months postoperatively. The primary outcome was early recurrence, defined as postoperative exodeviation over 11 prism diopters at any time beyond postoperative month 1 and within 24 months. Survival was estimated by the Kaplan-Meier method. Preoperative and postoperative clinical characteristics were collected from patients, and preoperative and postoperative Cox proportional hazards regression analyses were performed. Preoperative model was fit with 9 preoperative clinical factors (sex, onset age of exotropia, duration of disease, spherical equivalent of the more myopic eye, preoperative distant exodeviation, near stereoacuity, distant stereoacuity, near control, and distant control). Postoperative model was fit by adding 2 factors relevant to surgery (surgery type and immediate postoperative deviation). Corresponding nomograms were constructed and evaluated using the concordance indexes (C-indexes) and calibration curves. Decision curve analysis (DCA) was used to determine the clinical utility. RESULTS: The recurrence rate was 8.10% for 6 months, 11.90% for 12 months, 17.14% for 18 months, and 27.14% for 24 months after surgery. Younger age at onset, larger preoperative angle, and less immediate postoperative overcorrection were found to increase the risk for recurrence. Although onset age and age at surgery were strongly correlated in this study, age at surgery was not significantly associated with IXT recurrence. The C-indexes for the preoperative and postoperative nomograms were 0.66 (95% CI: 0.60-0.73) and 0.74 (95% CI: 0.68, 0.79), respectively. Calibration plots between predicted and actual observed 6-, 12-, 18-, and 24-month overall survival using the 2 nomograms revealed high consistency. The DCA indicated that both models yielded great clinical benefits. CONCLUSIONS: By relatively accurate weighing of each risk factor, the nomograms offer good prediction for early recurrence in IXT patients and may help clinicians and individual patients make appropriate intervention plans.

Retinochoroidal microvascular changes in newly developed obese children: an optical coherence tomography angiography study.

BACKGROUND: Childhood obesity was associated with retinochoroidal microvascular changes using optical coherence tomography angiography (OCTA), but obesity duration was neglected. Obesity is chronic and progressive and obesity duration is related to microvascular function. Thus, it is important to identify microvascular changes in obese children timely to allow possible interventions with the increase in the number of obese children. This pilot study aimed to characterize retinochoroidal microvascular changes in newly developed obese children compared to age- and sex-matched controls. METHODS: Forty newly developed obese children and 40 age- and sex-matched controls were recruited. All subjects completed comprehensive eye examinations, including axial length, cycloplegic refraction, optical coherence tomography angiography scans (AngioVue; Optovue Inc), etc. RESULTS: There were no statistically significant differences between groups in terms of month age (P = 0.927), spherical equivalent refraction (P = 0.753) and axial length (P = 0.196). Newly developed obese children had lower vessel density (VD) in the inferior parafovea (P = 0.026), nasal parafovea (P = 0.038) and temporal perifovea (P = 0.026) of deep vascular complex (DVC), higher VD in the fovea of superficial vascular complex (P = 0.021) and the fovea of DVC (P = 0.016), and smaller foveal avascular zone (P = 0.003) when compared to controls. Also, no apparent differences in any quadrant of total retinal thickness, subfoveal choroidal thickness (SFCT), and choriocapillaries fow voids were detected (all P > 0.05). CONCLUSION: Retinochoroidal microvascular changes had already occurred in newly developed obese children, so early screening and close follow-up eye examinations were recommended; Retinal microvascular insult may precede its structural change and that retina may be a better candidate to predict the onset of retinochoroidal microvascular changes than choroid in obese children.

The Development of the Chinese Intermittent Exotropia Questionnaire.

PURPOSE: The Intermittent Exotropia Questionnaire (IXTQ) is a child, proxy, and parent report of health-related quality of life specific to children with intermittent exotropia (IXT). The present study aimed to develop a Chinese-language version of the IXTQ (CIXTQ) and evaluate its validity and reliability when used in Chinese IXT children and their parents. METHODS: The IXTQ was translated into Chinese. One hundred seventy-five IXT children (2 to 17 years old) and 151 orthotropic control children (2 to 17 years old) along with one of their parents were recruited. Children 5 to 17 years old completed the 5- to 7-year-old or the 8- to 17-year-old child questionnaire of the CIXTQ according to their age. Parents of all children (2 to 17 years old) completed the proxy and parent questionnaires of the CIXTQ. Psychometric properties of the CIXTQ were examined for floor and ceiling effects, construct validity, item-internal consistency, discriminative validity, Cronbach α coefficient and test-retest reliability. RESULTS: No items were found to have strong floor or ceiling effects. Principal component analysis identified that the CIXTQ had a similar structure to the original English version. The median scores of each questionnaire in the CIXTQ among children with IXT and their parents were significantly lower than those among control subjects (P < .001). Cronbach α coefficients ranged from 0.869 to 0.931, and test-retest reliabilities ranged from 0.898 to 0.981, for each questionnaire in the CIXTQ. CONCLUSIONS: The CIXTQ is a useful tool to evaluate the influence of IXT on health-related quality of life among Chinese IXT children and their parents.

Polyamidoamine dendrimer conjugated chitosan nanoparticles for the delivery of methotrexate.

Encapsulating anticancer drugs to synthetic polymer is a promising approach to improve the efficiency and reduce the side effects of anticancer drugs. In this study, novel chitosan derivatives with polyamidoamine moieties (CS-PAMAM) were synthesized and characterized by morphology, particle size, and zeta potential. Then the anticancer drug-methotrexate-encapsulated CS-PAMAM was prepared by hydrophobic-hydrophilic interactions. The drug release assay showed that the amount of the methotrexate release from CS-PAMAM was pH depended. Meanwhile, the cell viability assay illustrated that CS-PAMAM was suitable for the drug delivery because of its low cytotoxicity on cells. Moreover, our results showed that the CS-PAMAM could significantly improve the cytotoxicity of free methotrexate on A549 cells. These results demonstrate that CS-PAMAM may provide a suitable platform for the water-insoluble drug delivery.