Evaluation of a novel deep learning based screening system for pathologic myopia.

AIM: To evaluate the clinical application value of the artificial intelligence assisted pathologic myopia (PM-AI) diagnosis model based on deep learning. METHODS: A total of 1156 readable color fundus photographs were collected and annotated based on the diagnostic criteria of Meta-pathologic myopia (PM) (2015). The PM-AI system and four eye doctors (retinal specialists 1 and 2, and ophthalmologists 1 and 2) independently evaluated the color fundus photographs to determine whether they were indicative of PM or not and the presence of myopic choroidal neovascularization (mCNV). The performance of identification for PM and mCNV by the PM-AI system and the eye doctors was compared and evaluated via the relevant statistical analysis. RESULTS: For PM identification, the sensitivity of the PM-AI system was 98.17%, which was comparable to specialist 1 (P=0.307), but was higher than specialist 2 and ophthalmologists 1 and 2 (P<0.001). The specificity of the PM-AI system was 93.06%, which was lower than specialists 1 and 2, but was higher than ophthalmologists 1 and 2. The PM-AI system showed the Kappa value of 0.904, while the Kappa values of specialists 1, 2 and ophthalmologists 1, 2 were 0.968, 0.916, 0.772 and 0.730, respectively. For mCNV identification, the AI system showed the sensitivity of 84.06%, which was comparable to specialists 1, 2 and ophthalmologist 2 (P>0.05), and was higher than ophthalmologist 1. The specificity of the PM-AI system was 95.31%, which was lower than specialists 1 and 2, but higher than ophthalmologists 1 and 2. The PM-AI system gave the Kappa value of 0.624, while the Kappa values of specialists 1, 2 and ophthalmologists 1 and 2 were 0.864, 0.732, 0.304 and 0.238, respectively. CONCLUSION: In comparison to the senior ophthalmologists, the PM-AI system based on deep learning exhibits excellent performance in PM and mCNV identification. The effectiveness of PM-AI system is an auxiliary diagnosis tool for clinical screening of PM and mCNV.

Ivermectin, a potential anticancer drug derived from an antiparasitic drug.

Ivermectin is a macrolide antiparasitic drug with a 16-membered ring that is widely used for the treatment of many parasitic diseases such as river blindness, elephantiasis and scabies. Satoshi omura and William C. Campbell won the 2015 Nobel Prize in Physiology or Medicine for the discovery of the excellent efficacy of ivermectin against parasitic diseases. Recently, ivermectin has been reported to inhibit the proliferation of several tumor cells by regulating multiple signaling pathways. This suggests that ivermectin may be an anticancer drug with great potential. Here, we reviewed the related mechanisms by which ivermectin inhibited the development of different cancers and promoted programmed cell death and discussed the prospects for the clinical application of ivermectin as an anticancer drug for neoplasm therapy.

Recent developments in regenerative ophthalmology.

Regenerative medicine (RM) is one of the most promising disciplines for advancements in modern medicine, and regenerative ophthalmology (RO) is one of the most active fields of regenerative medicine. This review aims to provide an overview of regenerative ophthalmology, including the range of tools and materials being used, and to describe its application in ophthalmologic subspecialties, with the exception of surgical implantation of artificial tissues or organs (e.g., contact lens, artificial cornea, intraocular lens, artificial retina, and bionic eyes) due to space limitations. In addition, current challenges and limitations of regenerative ophthalmology are discussed and future directions are highlighted.

One-year follow-up evaluation of combined phacovitrectomy for idiopathic epiretinal membrane.

AIM: To evaluate the therapeutic effect of combined phacovitrectomy with membrane peeling and intraocular lens (IOL) implantation in patients with severe idiopathic epiretinal membrane (iERM) and concurrent cataract. METHODS: A total of 34 eyes from 34 patients who underwent phacovitrectomy and epiretinal membrane (ERM) peeling at the First Affiliated Hospital of Zhejiang University between 2015 and 2017. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured preoperatively and at 1, 3, 6mo and 1y postoperatively. Temporal changes and bivariate correlations of these parameters were analyzed. RESULTS: Mean logMAR BCVA improved and CFT decreased significantly (P<0.001) until 6mo after surgery. Correlation analysis revealed a positive correlation between preoperative and postoperative logMAR BCVA (r=0.716, P<0.001 at 1mo, r=0.417, P=0.014 at 3mo, r=0.359, P=0.037 at 6mo, and r=0.369, P=0.032 at 12mo post-op respectively), but preoperative CFT was neither associated with postoperative CFT nor with postoperative logMAR BCVA. There was a positive correlation between CFT and logMAR BCVA at 1mo (r=0.346, P=0.045), 6mo (r=0.347, P=0.045), and 12mo (r=0.342, P=0.048) post-operatively. The intra- and postoperative complications were relatively mild, and the incidences were generally low. CONCLUSION: For severe iERM patients with significant visual symptoms, combined phacovitrectomy with membrane peeling and IOL implantation is safe and effective in improving BCVA and decreasing CFT. Early surgery in selected patients may help preserving better visual function.

MicroRNA-34a suppresses human lens epithelial cell proliferation and migration via downregulation of c-Met.

MicroRNAs (miRNAs) are endogenously expressed, non-coding, small RNAs which inhibit protein translation through binding to target mRNAs. Recent studies have demonstrated that miRNAs participate in the regulation of a variety of cell structures and functions including those for cell proliferation and migration. MicroRNA-34a (miR-34a), a potential effector of the p53 tumor suppressor gene, is extensively studied for its suppression of cell growth. In the present study, we investigated the function of miR-34a in human lens epithelial cells. Following confirming that miR-34a expression was increased in a P53 dependent manner in human lens epithelial cells after treatment with doxorubicin, we demonstrated that overexpression of miR-34a in the human lens epithelial cell line HLE B3 led to a significant decrease in cell proliferation and migration, with the use of MTS and transwell migration assays. Moreover, HGF enhanced the proliferation and migration of human lens epithelial cells. miR-34a was found to downregulate the expression of c-Met protein by Western blotting. Furthermore, overexpression of miR-34a downregulated the levels of phosphorylated Akt, phosphorylated ERK1/2 and other cell cycle regulators. miR-34a expression was significantly reduced in posterior capsule opacification (PCO) clinical samples. These results demonstrate that miR-34a may act as a suppressor in PCO by regulating human lens epithelial cell proliferation and migration through downregulation of c-Met.

A review of combined phacoemulsification and endoscopic cyclophotocoagulation: efficacy and safety.

As cataract occurs frequently in patients with glaucoma, combining phacoemulsification and endoscopic cyclophotocoagulation has been gaining attention recently due to its minimally invasive nature. A variety of studies had evaluated the efficacy and safety of this procedure and had shown extremely promising results. This review article has shown here that combined phacoemulsification and endoscopic cyclophotocoagulation procedure could effectively reduce intraocular pressure in medically uncontrolled glaucoma patients while avoiding serious complications associated with traditional cyclophotocoagulation procedure and adverse effects related to filtering surgery such as trabeculectomy.

Association of the polymorphism Y402H in the CFH gene with response to anti-VEGF treatment in age-related macular degeneration: a systematic review and meta-analysis.

To explore whether the complement factor H (CFH) polymorphism rs1061170/Y402H is associated with responsiveness to antivascular endothelial growth factor (VEGF) agents in age-related macular degeneration (AMD). We reviewed the English literature to examine the association between the polymorphism rs1061170/Y402H of the CFH gene and responsiveness to treatment with anti-VEGF drugs in AMD patients. A meta-analysis of eligible studies was also performed. Pooled odds ratios (ORs) and 95% CIs were estimated using Stata V.12.0. Statistical heterogeneity was measured using Q-statistic testing. Fourteen relevant studies including a total of 2963 AMD patients were eligible. In AMD patients without a treatment history, individuals carrying the rs1061170/Y402H TT genotype were more likely to achieve a better outcome (OR = 1.932, 95% CI = 1.125-3.317, p = 0.017) than those carrying the CC genotype. The polymorphism rs1061170/Y402H might be a genetic predictor of treatment response to anti-VEGF therapy in AMD patients. Further prospective research including a larger number of patients is needed to validate this finding.

Evaluation of Intravitreal Ranibizumab on the Surgical Outcome for Diabetic Retinopathy With Tractional Retinal Detachment.

This study aims to investigate intravitreal injection of Ranibizumab on the surgical outcome for diabetic patients who had tractional retinal detachment but did not receive any preoperative retinal photocoagulation.Ninety-seven patients (97 eyes) who had diabetic retinopathy with tractional retinal detachment were enrolled to receive 23-G pars plana vitrectomy (PPV). They were assigned to an experimental group (Group I, n = 47 eyes) and a control group (Group II, n = 50 eyes). The patients in Group I were given 1 injection of intravitreal Ranibizumab (Lucentis 0.5 mg/0.05 mL) 1 week before surgery, whereas those in Group II went down to surgery directly. Follow-ups were performed for 6 months to 3 years (16 ±â€Š6 months), and indicators observed included postoperative best-corrected visual acuity, complications, and retinal thickness in the macula measured by optical coherence tomography.In Group I, BCVA improved from logMAR 1.92 ±â€Š0.49 to logMAR 0.81 ±â€Š0.39 following surgery, whereas in Group II, BCVA improved from logMAR 1.91 ±â€Š0.49 to logMAR 0.85 ±â€Š0.41. There was significant postoperative gain in vision, but there was no significant difference between the 2 groups at postoperative follow-up visits. The mean duration of vitrectomy in Group I and Group II was (40 ±â€Š7) minutes and (53 ±â€Š9) minutes, respectively, with significant difference. Iatrogenic breaks were noted in 5 eyes (11%) in the experimental group and 17 eyes (34%) in the control group; the difference was significant. The retinal thickness in the macula measured by OCT was (256 ±â€Š44) µm and (299 ±â€Š84) µm in Group I and Group II respectively with significant difference. Besides, there were significantly more eyes in Group II that required silicone oil tamponade and postoperative retinal photocoagulation.23-G PPV combined with intravitreal tamponade and panretinal photocoagulation still remains an effective regimen for the treatment of diabetic retinopathy complicated with tractional retinal detachment. Preoperative intravitreal injection of Ranibizumab could shorten surgical duration, reduce intraoperative complications, and sometimes spare the need for silicone oil tamponade and postoperative retinal photocoagulation, alleviating patients' suffering from surgery.

[Comparison of corneal nerve regeneration and dry eye condition after conventional LASIK and femtosecond-assisted LASIK].

OBJECTIVE: To compare the regeneration of subbasal epithelial nerve plexus in the central cornea and dry eye condition between patients undergoing conventional LASIK surgery and femtosecond-assisted LASIK surgery. METHODS: It was across-sectional study. Thirty patients (60 eyes) who had LASIK at our hospital from October 2011 to September 2012 were included in this study. Patients were divided into conventional LASIK group and femtosecond-assisted LASIK group based on the method used for corneal flap creation. Subjective and objective dry eye tests were carried out at 1 year after surgery. HRT III confocal microscopy was used to observe the regeneration of subbasal epithelial nerve plexus, and the images were analyzed by ACCMetrics software using quantitative parameters to determine the density and morphology of corneal nerve fibers. The data of corneal nerve fibers and dry eye condition in the two groups undergoing different LASIK procedures was compared using an independent sample t test. RESULTS: During the one-year postoperative follow-up, the Schirmer test result, tear film break-up time value, and ocular surface disease index score in the F-LASIK group [(12.65 +/- 8.73) mm/5min, (7.85 +/- 2.81) s, (7.25 +/- 6.35) points] were not significantly different from that in the C-LASIK group [(6.73 +/- 10.55) mm/ 5 min, (8.77 +/- 3.04) s, (4.46 +/- 5.37) points] (t =1.399, -1.050, -1.613, P > 0.05). Regarding the nerve fiber measurements, which included corneal nerve fiber density, corneal nerve branch density, corneal nerve fiber length, corneal total branch node, corneal nerve fiber width, and corneal nerve fiber tortuosit, there was no statistically significant difference in their results between patients who had femtosecond-assisted LASIK surgery [(16.46 +/- 6.65 )/mm2, (19.27 +/- 9.56)/mm2, (10.88 +/- 4.70) mm/mm2, (65.10 +/- 38.43)/mm2, (4.76 +/- 0.34) microm, (2.30 +/- 0.34) grades] and those who had conventional LASIK surgery [(15.99 +/- 7.14)/mm2, (19.39 +/- 7.07)/mm2, (11.30 +/- 3.17) mm/mm2, (68.43 +/- 34.94)/mm2, (4.73 +/- 0.24) microm, (2.14 +/- 0.34) grades] (t = -0.229, 0.049, 0.365, 0.306, -0.394, -1.629, P > 0.05). CONCLUSION: The difference between conventionalLASIK and femtosecond-assisted LASIK does not significantly affect the dry eye test values and nerve fiber measurements in patients at 1 year after LASIK.

[Comparison of clinical effects of bromfenac sodium ophthalmic solution 0.1% versus glucocorticoids for post-LASEK usage].

OBJECTIVE: To evaluate the safety, effectiveness and compliance of Bronuck (bromfenac sodium ophthalmic solution 0.1%) following LASEK in comparison with glucocorticoids. METHODS: In this prospective trial, 60 patients (120 eyes) undergoing LASEK were randomized into the bromfenac sodium group (60 eyes) and control group (60 eyes). Patients in both groups initially received dexamethasone 0.1% four times a day after LASEK for 7 days, and then the patients in the bromfenac sodium group were given Bronuck twice a day for the next 11 weeks, while the patients from the control group were given fluorometholone 0.1% with gradually decreased doses during the same period. Results of the routine examinations done before and 3, 10, 30, 90 and 180 days after LASEK were recorded, including uncorrected visual acuity, best corrected visual acuity, intraocular pressure (IOP), corneal topography, ocular symptoms and signs, which were used for comparison between the two groups. All data of right eyes were analyzed for their independence, normality and homogeneity of variance. Independent samples t-test or non-parametric Mann-Whitney test was performed accordingly. RESULTS: There was no statistically significant difference in IOP and corneal topography (K1, K2, SAI, SRI and CY) between the two groups postoperatively. The IOP was (16.33 ± 6.21) mmHg(1 mmHg = 0.133 kPa), (15.67 ± 2.82) mmHg, (15.35 ± 2.22) mmHg and (13.10 ± 3.41) mmHg in the bromfenac sodium group, and (16.87 ± 3.68) mmHg, (14.05 ± 2.23) mmHg, (14.39 ± 2.22) mmHg and (13.18 ± 2.49) mmHg in the control group at 10, 30, 90 and 180 days, respectively. The bromfenac sodium group showed significantly better uncorrected visual acuity (5.16 ± 0.08) than the control group (5.02 ± 0.09) on day 30 (t = 2.32, P < 0.05). In the bromfenac sodium group, four eyes had visual fatigue, and four eyes had dry eye symptoms on day 180. Epithelial flaps were all well positioned with satisfying healing process. Each group had one case (two eyes) of haze on day 30, and the bromfenac sodium group had another case (2 eyes) of new-onset haze on day 60. But all the cases of haze were graded 0.5 according to the Fantes Standard, too mild to compromise their visual acuities, and were resolved after frequent topical medication for 1 month. Four patients from the control group were prescribed antiglaucoma medications due to elevated IOP. The refractive status remained stable for patients from both groups. CONCLUSIONS: Administration of Bronuck can reduce the amount of or partially substitute for corticosteroids. Mild haze early after LASEK may disappear after intensive treatment.

[Diagnosis and treatment of cytomegalovirus endotheliitis].

Cytomegalovirus endotheliitis is an inflammation of the corneal endothelium caused by cytomegaloviruses. It may represent a newly identified clinical entity that has drawn increasing attention since cytomegalovirus DNA was detected from the aqueous humor of a patient with corneal endotheliitis. Its pathogenesis is still unclear, and it typically presents as corneal edema, coin-shaped/linear keratic precipitates, mild anterior chamber inflammation and with or without raised intraocular pressure in an otherwise healthy individual. In order to make an accurate diagnosis, the patient's medical history, clinical manifestations and ocular signs should all be considered, and further detection of pathogens by PCR from the ocular tissue should be done. However, misdiagnoses may occur because cytomegalovirus endotheliitis can mimic other clinical diagnoses. Patients with cytomegalovirus endotheliitis respond to systemic and topical ganciclovir with the use of topical steroids. Therefore, making an accurate early diagnosis is crucial in preventing loss of corneal endothelial cells. Moreover, if left undiagnosed, these eyes often receive increasing amounts of immunosuppressants in attempts to control the inflammation, which may worsen the ocular infection, thus compromising their visual outcomes.