Meta-analysis of efficacy, safety, stability and predictability of Small Incision Lenticule Extraction (SMILE) for myopia.

In order to investigate the postoperative efficacy, safety, stability, and predictability of SMILE surgery as a treatment for myopia, a comprehensive search was conducted in April 2023 across prominent databases, including PubMed, EMBASE, Web of Science, and Cochrane Library. The search aimed to select relevant studies of randomized controlled trials (RCTs) comparing clinical outcomes between SMILE and other corneal refractive surgeries for myopia. Upon conducting the initial search, a total of 324 records were retrieved from the aforementioned databases. These records were subjected to a meticulous selection process, adhering to predetermined inclusion criteria, resulting in 17 studies being ultimately included for analysis. By pooling the results of these studies, the comparison between SMILE surgery and alternative corneal refractive surgeries demonstrated similar outcomes in terms of efficacy, safety, stability, predictability, and higher-order aberrations (HOAs) concerning the correction of myopia. Furthermore, it was observed that the SMILE procedure exhibited a lesser impact on corneal sensation and corneal nerve density compared to other corneal refractive surgeries. Based on these findings, SMILE surgery may be considered as a treatment option with a slight superiority over conventional corneal surgery for myopia.

Visual and auditory attention defects in children with intermittent exotropia.

BACKGROUND: Previous studies have shown that children with intermittent exotropia (IXT) have a higher rate of psychiatric abnormalities as they grow up, such as attention deficit. This study explored visual and hearing attention among children with IXT, and evaluated its association with clinical characteristics and cognitive development. METHODS: Forty-nine children with a diagnosis of IXT and 29 children with traditional development were recruited. The Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) was used to measure the subjects' full-scale response control quotient (FSRCQ), full-scale attention quotient (FSAQ), auditory response control quotient (ARCQ), auditory attention quotient (AAQ), visual response control quotient (VRCQ), and visual attention quotient (VAQ). The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) was used to assess their cognitive function. The differences between the scores of children with IXT and normal controls were analyzed. RESULTS: The results showed that the FSRCQ, FSAQ, ARCQ, AAQ, VRCQ, and VAQ of children with IXT were all lower than those of normal controls with the same age (P < 0.05). The level of attention was significantly correlated with the age of strabismus onset (P < 0.05), but not with the degree of strabismus, stereopsis, or fusion control score. In addition, audiovisual attention was correlated significantly with their cognitive development level. The random forest classifier prediction model showed that age of strabismus onset was an important predictor of attention. CONCLUSION: Children with IXT have lower visual and auditory attention and control than their peers, and the age of onset of strabismus may be a major factor.

Altered whole-brain gray matter volume in form-deprivation myopia rats based on voxel-based morphometry: A pilot study.

Background: Myopia is one of the major public health problems worldwide. However, the exact pathogenesis of myopia remains unclear. This study proposes using voxel-based morphometry (VBM) to investigate potential morphological alterations in gray matter volume (GMV) in form-deprivation myopia (FDM) rats. Methods: A total of 14 rats with FDM (FDM group) and 15 normal controls (NC group) underwent high-resolution magnetic resonance imaging (MRI). Original T2 brain images were analyzed using VBM method to identify group differences in GMV. Following MRI examination, all rats were perfused with formalin, and immunohistochemical analysis of NeuN and c-fos levels was performed on the visual cortex. Results: In the FDM group, compared to the NC group, significantly decreased GMVs were found in the left primary visual cortex, left secondary visual cortex, right subiculum, right cornu ammonis, right entorhinal cortex and bilateral molecular layer of the cerebellum. Additionally, significantly increased GMVs were found in the right dentate gyrus, parasubiculum, and olfactory bulb. Conclusions: Our study revealed a positive correlation between mGMV and the expression of c-fos and NeuN in the visual cortex, suggesting a molecular relationship between cortical activity and macroscopic measurement of visual cortex structural plasticity. These findings may help elucidate the potential neural pathogenesis of FDM and its relationship to changes in specific brain regions.

Comparison of Functional Vision and Eye-Related Quality of Life between Myopic Children Treated with Orthokeratology and Single-Vision Spectacles in Southern China.

Objective: To compare eye-related quality of life between Chinese children wearing orthokeratology (OK) contact lenses and single-vision spectacles (SVS) using the Pediatric Eye Questionnaire (PedEyeQ) and to evaluate the impact of different myopia correction methods on children and their parents. Methods: Children aged 12-17 years and their parents/legal guardians were recruited. The children's myopia ranged from -0.50 to -5.00 diopters (D), and their astigmatism was <1.50 D. They had all been wearing OK contact lenses or SVS for at least 12 months. The children completed the Child PedEyeQ. One of their parents (or a legal guardian) completed the Proxy PedEyeQ and the Parent PedEyeQ. Rasch-calibrated PedEyeQ scores were calculated for each domain and were converted to a scale from 0 to 100 for statistical analysis. Results: A total of 50 children wearing OK contact lenses, 43 children wearing SVS, and their parents/legal guardians completed the questionnaires. The scores of all Child, Proxy, and Parent PedEyeQ domains in the OK contact lens group were higher than those in the SVS group (all P < 0.05). In the mild and moderate myopia subgroups, the Child, Proxy, and Parent PedEyeQ scores in the mild myopia OK contact lens subgroup were higher than those in the mild myopia SVS group (all P < 0.05) except functional vision and bothered by eyes/vision domains for the proxy PedEyeQ. Similarly, the Child, Proxy, and Parent PedEyeQ scores in the moderate myopia OK contact lens subgroup were higher than those in the moderate myopia SVS subgroup (all P < 0.05) except impact on parent and family domain for the parent PedEyeQ. In the subgroup analysis of glasses type, no significant score difference of any Child, Proxy, and Parent PedEyeQ domain was detected between mild and moderate myopia in either the OK contact lens group or the SVS group (all P > 0.05). Conclusion: Compared with children wearing SVS, children wearing OK contact lenses have better functional vision and eye-related quality of life. Moreover, OK contact lens has a better correction effect, higher acceptance rates, and less impact on parents and families than SVS.

Prevalence, Characteristics, and Risk Factors of Retinal Hemorrhage among Full-Term Neonates in Southern China.

Neonatal retinal hemorrhage (RH) is the most common ocular fundus disease among newborns. Early detection and timely intervention are vital for reducing the risk of visual impairment caused by RH. However, little is known about the prevalence, characteristics, and risk factors of RH in southern China. Full-term infants born in Qingyuan City during the first 10 days of each month in 2021 were included in this study. All infants underwent RetCam III retinal examinations. Detailed information on retinal hemorrhage, including involved eyes, bleeding severity, and affected area (extrafoveal macula, fovea, or optic disc), and clinical information on the neonates and their mothers was collected. The results showed that among the 1072 eligible neonates, 266 (24.8%) had neonatal retinal hemorrhage. Consistent bilateral retinal hemorrhage severity was observed in 83.2% of the cases. The prevalence of optic disc involved RH, extrafoveal macular involved RH and foveal involved RH were 23.7%, 81.2% and 2.63%, respectively. Multivariate logistic regression analysis showed that lower birth weight (OR, 0.63; 95% CI, 0.40-0.99; p < 0.05) and vaginal delivery (OR, 20.6; 95% CI, 9.10-46.5; p < 0.001) were risk factors of neonatal RH. The area under the ROC curve of vaginal delivery, combined with birth weight, as predictors of neonatal RH was 0.73, with 85.3% sensitivity and 23.9% specificity. The birth weight cutoff was 3460 g. Our results suggested that neonatal RH is common in full-term neonates in southern China. It usually has the same severity in both eyes and mostly involves the extrafoveal macular region. Vaginal delivery and low birth weight are risk factors for neonatal RH.

ROP-like retinopathy in full/near-term newborns: A etiology, risk factors, clinical and genetic characteristics, prognosis and management.

Purpose: Retinopathy of prematurity (ROP) like retinopathy (ROPLR) could occur in full/near-term newborns. The causes and clinical features are still largely elusive. This study focused on the risk factors, clinical and genetic characteristics, treatment and outcome, and prognosis of ROPLR. Methods: A total of 47 consecutive full/near-term newborns during 2016-2017 with ROPLR were included. The clinical and genetic characteristics, treatment and outcome, prognosis, and potential underlying etiology of ROPLR were were analyzed. Results: 91 eyes of 47 infants were found to have ROPLR. The ROPLR regressed completely in 65.9% and partially in 20.9% of eyes without any interventions. Retinal changes of family exudative vitreoretinopathy (FEVR) were allocated in 12 neonates (group A), perinatal hypoxia-ischemia were categorized in 17 neonates (group B), and the other 18 neonates were categorized in group C. Compared to those in group B/C, infants in group A had significantly more severe retinopathy (stage 4/5, p < 0.001) and more treatments (p < 0.00 risk factor 1). Conclusions: Perinatal hypoxia-ischemia might be a major risk factor for ROPLR, in which spontaneous regression was common. FEVR, confirmed by positive family findings and genetic testing, might be the second risk factor of ROPLR, in which retinopathy is more severe and treatment is needed.

A cohort study of T helper 17 cell-related cytokine levels in tear samples of systemic lupus erythematosus and Sjögren's syndrome patients with dry eye disease.

OBJECTIVES: Sjögren's syndrome (SS) is the most common autoimmune disease with dry eye (DE) syndrome and some systemic lupus erythematosus (SLE) patients are also with DE syndrome. The occurrence of immune-related DE disease is closely related to T helper (Th) 17 cells in SS patients, and SLE patients have abnormal levels of multiple Th17 cell-related cytokines in their blood. However, the degree of expression of these cytokines in blood differs from that in tears. We hypothesised that the occurrence of DE symptoms in SLE and SS patients may be related to Th17 cells. METHODS: In this study, Th17 cell-related cytokines, including interleukin (IL)-1ß, IL-2, IL-4, interferon-γ, IL 6, IL-8, IL-17F, tumour necrosis factor (TNF)-α, IL-21, IL-22, and IL-23 were analysed in tear samples of DE, SLE, and SS patients. Ocular surface examinations for patients with DE symptoms, including tear secretion test (Schirmer I Test, SIT) and tests for ocular surface disease index (OSDI), tear break-up time (BUT), and corneal fluorescein stain (CFS), were performed and compared between the following patient groups: normal healthy people (control group, n=30), patients with simple DE disease (DE group, n=13), SLE patients with DE disease (SLE group, n=17), and SS patients with DE disease (SS group, n=18). RESULTS: The expression of Th17 cell-related cytokines in each tear sample was analysed using Luminex assay. The SIT and BUT scores of the SLE group were lower than those of the control (p<0.001) and DE (p<0.05) groups. However, SIT, BUT, CFS, and OSDI scores were not significantly different between SLE and SS patients. TNF-α, IL-6, IL-8, and IL-21 levels in tear samples were higher in DE, SLE, and SS patients (p<0.05) than in control individuals. IL-2 and IL-4 levels in tear samples of SLE patients were higher than DE (p<0.001) but lower than the control (p<0.001) group patients. IL-23 levels in tear samples of DE, SLE, and SS patients were all lower than those in the control group (p<0.001). SIT, BUT, CFS, and OSDI results showed that the DE symptoms of SLE and SS patients were more severe than those of the DE group. CONCLUSIONS: It is known that cytokine expression levels in tears are different from those in blood. Abnormal regulation of the Th17 cell pathway may be related to the occurrence of DE disease in SLE and SS patients, and Th17 cell-related cytokines, such as IL-8 and IL-21, may be potential therapeutic targets for treating SLE or SS DE disease.

Automated Explainable Multidimensional Deep Learning Platform of Retinal Images for Retinopathy of Prematurity Screening.

Importance: A retinopathy of prematurity (ROP) diagnosis currently relies on indirect ophthalmoscopy assessed by experienced ophthalmologists. A deep learning algorithm based on retinal images may facilitate early detection and timely treatment of ROP to improve visual outcomes. Objective: To develop a retinal image-based, multidimensional, automated, deep learning platform for ROP screening and validate its performance accuracy. Design, Setting, and Participants: A total of 14 108 eyes of 8652 preterm infants who received ROP screening from 4 centers from November 4, 2010, to November 14, 2019, were included, and a total of 52 249 retinal images were randomly split into training, validation, and test sets. Four main dimensional independent classifiers were developed, including image quality, any stage of ROP, intraocular hemorrhage, and preplus/plus disease. Referral-warranted ROP was automatically generated by integrating the results of 4 classifiers at the image, eye, and patient levels. DeepSHAP, a method based on DeepLIFT and Shapley values (solution concepts in cooperative game theory), was adopted as the heat map technology to explain the predictions. The performance of the platform was further validated as compared with that of the experienced ROP experts. Data were analyzed from February 12, 2020, to June 24, 2020. Exposure: A deep learning algorithm. Main Outcomes and Measures: The performance of each classifier included true negative, false positive, false negative, true positive, F1 score, sensitivity, specificity, receiver operating characteristic, area under curve (AUC), and Cohen unweighted κ. Results: A total of 14 108 eyes of 8652 preterm infants (mean [SD] gestational age, 32.9 [3.1] weeks; 4818 boys [60.4%] of 7973 with known sex) received ROP screening. The performance of all classifiers achieved an F1 score of 0.718 to 0.981, a sensitivity of 0.918 to 0.982, a specificity of 0.949 to 0.992, and an AUC of 0.983 to 0.998, whereas that of the referral system achieved an F1 score of 0.898 to 0.956, a sensitivity of 0.981 to 0.986, a specificity of 0.939 to 0.974, and an AUC of 0.9901 to 0.9956. Fine-grained and class-discriminative heat maps were generated by DeepSHAP in real time. The platform achieved a Cohen unweighted κ of 0.86 to 0.98 compared with a Cohen κ of 0.93 to 0.98 by the ROP experts. Conclusions and Relevance: In this diagnostic study, an automated ROP screening platform was able to identify and classify multidimensional pathologic lesions in the retinal images. This platform may be able to assist routine ROP screening in general and children hospitals.

What Is Left After Resolution of Neonatal Retinal Hemorrhage: The Longitudinal Long-term Outcome in Foveal Structure and Visual Function.

PURPOSE: Neonatal retinal hemorrhage (NRH) is one of the most common neonatal fundus conditions. Hemorrhage resolves spontaneously; however, its long-term outcome is unknown yet. The current study explores the long-term role of NRH in foveal structure and visual function. DESIGN: Cohort study (a prospective longitudinal study, in which the participants were followed up for 4-6 years). METHODS: A total of 125 healthy newborns during 2013-2015, including 50 newborns with NRH and 75 newborns without NRH, were enrolled. The eyes with NRH were further categorized into the foveal hemorrhage (FH) group and non-FH group. A comprehensive ophthalmic examination including best-corrected visual acuity (BCVA) measurement, slit-lamp examination, refractive error measurement, scanning laser ophthalmoscopy, and spectral-domain OCT was performed. Total retinal thickness (TRT) and the inner and outer retinal layers in the fovea were measured and compared. RESULTS: The NRH was absorbed within 2.1 ± 0.98 weeks (median: 3 weeks). No difference was noted in the demographic characteristics between the groups; there was no significant difference in the logMAR BCVA (P = .83) or in the TRT. Subgroup analysis showed that TRT at the fovea in the FH group was significantly thicker (P = .005). Segmentation analysis showed a significantly thicker foveal outer nuclear layer (ONL) in the FH group (P = .017). CONCLUSIONS: Birth-related retinal hemorrhage, even FH, might not lead to obvious visual abnormalities at the age of 4 years, at least according to this study with relatively small sample size. However, a thicker fovea, mainly attributed to a wider ONL and a shallower foveal pit, is noted in our study.

Ultralight, Strong and Renewable Hybrid Carbon Nanotubes Film for Oil-Water Emulsions Separation.

A novel ultralight superhydrophobic-superoleophilic hybrid Carbon Nanotubes (CNTs) film with double-layer structures is fabricated by using vacuum filtration method. The CNTs film can separate various surfactant-stabilized water-in-oil emulsions with a separation efficiency higher than 99.3%. Moreover, the hybrid films can be regenerated through a simple and rapid combustion process within 2 s. In addition, the CNTs film still retains good hydrophobic properties under the conditions of physical abrasion, and strong acidic and alkaline solutions, which shows the excellent durability. The hybrid CNTs film is ultralight, stable, and easily stored and reused. The outstanding features of the obtained CNTs films we present here may find many important applications in various fields like oil purification and wastewater treatment.

Silica Nanoparticles Reinforced Ionogel as Nonvolatile and Stretchable Conductors.

Ionogels combine the advantages of being conductive, stretchable, transparent and nonvolatile, which makes them suitable to be applied as conductors for flexible electronic devices. In this paper, a series of ionogels based on 1-ethyl-3-methylimidazolium ethyl-sulfate ([C2mim][EtSO4]) and polyacrylic networks were prepared. Silica nanoparticles (SNPs) were dispersed into the ionogel matrix to enhance its mechanical properties. The thermal, mechanical and electrical properties of the ionogels with various contents of crosslinking agents and SNPs were studied. The results show that a small amount of SNP doping just increases the breaking strain/stress and the nonvolatility of ionogels, as well as maintaining adequate conductivity and a high degree of transparency. Furthermore, the experimental results demonstrate that SNP-reinforced ionogels can be applied as conductors for dielectric elastomer actuators and stretchable wires, as well as for signal transmission.

Long non-coding RNA VIM Antisense RNA 1 (VIM-AS1) sponges microRNA-29 to participate in diabetic retinopathy.

AIMS: Long non-coding RNA (lncRNA) VIM Antisense RNA 1 (VIM-AS1) has been reported to be correlated with type 2 diabetes (T2D) susceptibility, while the roles of this lncRNA in T2D and its complications remain unclear. This study aimed to explore the role of VIM-AS1 in diabetic retinopathy (DR). METHODS: Gene expression levels in both human specimens and in vitro cultivated cells were determined by qPCR and western blot. Overexpression experiments were performed to analyze gene interactions. Cell apoptosis after transfections was detected by cell apoptosis assay. RESULTS: We found that VIM-AS1 was significantly downregulated in T2D patients in comparison with that in healthy controls. Specifically, the expression levels of VIM-AS1 were lowest among T2D patients complicated with DR. Bioinformatics analysis showed that VIM-AS1 can interact with microRNA 29 (miR-29), which is a critical player in high glucose-induced apoptosis of human retinal pigment epithelial cells (RPEs). Dual-luciferase assay also revealed the direct interaction between them. High glucose treatment led to upregulated miR-29 and downregulated VIM-AS1. However, overexpression of VIM-AS1 and miR-29 did not affect the expression of each other. Cell apoptosis analysis showed that overexpression of VIM-AS1 reduced the enhancing effects of miR-29 overexpression on RPEs cell proliferation. CONCLUSIONS: Therefore, VIM-AS1 may sponge miR-29 to participate in DR.