Orbital schwannoma with hyposmia as the only presentation: Case report and a literature review on differential diagnosis.

Orbital schwannoma is a rare benign tumor, originating from the Schwann cells of the orbital peripheral nerve sheath. Orbital schwannoma is easily misdiagnosed if the patient shows atypical presentations and atypical appearance on MRI imaging. A 56-year-old male experienced hyposmia for 1 year and was misdiagnosed with cavernous hemangioma pre-operation. This case was treated by surgery through the endoscopic trans-nasal approach. After operation, the patient had no recurrence or complications. Preoperative diagnosis for these cases remains difficult. Combined imaging modalities including computed tomography (CT) and magnetic resonance imaging (MRI) can help in differential diagnosis. Surgery is the main treatment modality for treating orbital schwannoma. Outcomes in most cases are favorable without complications or recurrence.

LncRNA CCAT1 sponges miR-218-5p to promote EMT, cellular migration and invasion of retinoblastoma by targeting MTF2.

Retinoblastoma (RB) is the primary neoplasms of the retina that is most common in pediatrics age. Long non-coding RNAs (lncRNAs) has been noticed for strong relation to the occurrence and progress of retinoblastoma. Previously, we have demonstrated that lncRNA colon cancer-associated transcript 1 (CCAT1) in two RB cell lines SO-RB50 and Y79 was obviously overexpressed, and notably, lncRNA CCAT1 attenuated miR-218-5p expressionand induced proliferation, cell migration and invasion. But, how lncRNA CCAT1 acts in RB development and the potential molecular mechanisms remain to be determined. In this study, the expression levels of lncRNA CCAT1 and miR-218-5p were evaluated in RB tissues by Q-PCR, which established the results in the cell lines. Further, lncRNA CCAT1 was shown to promote epithelial-to-mesenchymal transition (EMT), cellular migration and invasion of RB cells by functional analysis of downregulation and overexpression of lncRNA CCAT1 with specific siRNA and pcDNA transfection. By performing bioinformatics and dual luciferase reporter assay, we verified the direct interaction between lncRNA CCAT1 and miR-218-5p. Besides, bioinformatics analysis indicated that metal regulatory transcription factor 2 (MTF2) might be a potent novel target for miR-218-5p, which was further validated with luciferase reporter assay, Q-PCR and also Western blot analysis. Functional analysis and rescue analysis showed that lncRNA CCAT1 via competitive binding to miR-218-5p to modulate MTF2 expression thus accelerate EMT, cell migration and invasion of RB. In conclusion, here we identified the lncRNA CCAT1/miR-218-5p/MTF2 axis in RB cell lines. Our investigations on the function of lncRNA CCAT1 and the roles of the related molecules hint a novel potential target fo RB therapy.

Long non-coding RNA CCAT1 promotes human retinoblastoma SO-RB50 and Y79 cells through negative regulation of miR-218-5p.

OBJECTIVE: To investigate the regulatory role and potential mechanism of long non-coding RNAs (lncRNA) in human retinoblastoma (RB). METHODS: The lncRNA profile in RB tissues were analyzed by microarray and quantitative reverse transcription PCR (qRT-PCR). One of the identified lncRNAs (LncRNA CCAT1) was selected for further experiments. SO-RB50 and Y79 cells were transfected with negative control, siRNA targeting lncRNA CCAT1 (si-CCAT1) and si-CCAT1+miR218-5p inhibitor, respectively. lncRNA CCAT1 expression was measured by qRT-PCR. Cell proliferation, migration and invasion were detected by CCK8, wound scratching, and transwell assay, respectively. Apoptosis and cell cycle distribution were assessed by flow cytometry. Apoptosis- (cle-caspase-3, cle-caspase-9, Bax and Bcl-2) and cell cycle-related protein expression (cyclin B1, CDC2 and p-CDC2 (Thr161)) were analyzed by Western blot. RESULTS: lncRNA CCAT1 expression in SO-RB50 and Y79 cells was significantly inhibited after si-CCAT1 transfection (P<0.01). Both RB cells exhibited significantly reduced proliferation, migration and invasion abilities, but markedly increased apoptosis at 48h after si-CCAT1 transfection (P<0.05 or 0.01). RB cells in si-CCAT1+miR218-5p inhibitor group had significantly higher proliferation, migration and invasion, but notably lower apoptosis compared with si-CCAT1 group at 24 and 48h after transfection (all P<0.05 or 0.01). si-CCAT1 significantly increased the expression of cle-caspase-3, cle-caspase-9, Bax, but decreased Bcl-2 expression (P<0.01). The proportion of G2/M SO-RB50 and Y79 cells in siCCAT1 group was significantly increased compared with negative control group (P<0.01). LncRNA CCAT1 interference significantly reduced the expression of cyclin B1, CDC2 and p-CDC2 (Thr161) (P<0.01). CONCLUSION: LncRNA CCAT1 promotes the proliferation migration and invasion, and reduces cell apoptosis of SO-RB50 and Y79 cells, probably through negative modulation of miR-218-5p. Our study suggested lncRNA CCAT1 as a potential biomarker and therapeutic target for RB.

Association between polymorphisms of OGG1, EPHA2 and age-related cataract risk: a meta-analysis.

BACKGROUND: Evidences have identified the correlation of 8-oxoguanine DNA glycosylase-1 (OGG1) and eph-receptor tyrosine kinase-type A2 (EPHA2) polymorphisms in age-related cataract (ARC) risk. However, the results were not consistent. The objective of this study was to examine the role of these two gene polymorphisms in ARC susceptibility. METHODS: Eligible case-control studies published between January 2000 and 2015 were searched and retrieved in the electronic databases. The odds ratio with 95 % confidence interval (CI) was employed to calculate the strength of the relationship. RESULTS: We totally screened out six articles, including 5971 cataract patients and 4189 matched controls. Three variants were contained (OGG1 rs1052133; EPHA2 rs7543472 and rs11260867). For OGG1 rs1052133, we detected a significant correlation between OGG1 polymorphism and ARC risk under the heterogenous model (CG vs. CC: OR = 1.34, 95 % CI = 1.06-1.70, P = 0.01) and dominant model (GG+CG vs. CC: OR = 1.45, 95 % CI = 1.16-1.81, P = 0.001), especially in patients with cortical cataract of subgroup analysis by phenotypes (P < 0.05). For EPHA2 rs7543472 and rs11260867, we did not find a positive association between these two mutations and ARC susceptibility in total cases. Subgroup analysis by phenotypes of cataract showed that only in cortical cataract, genotypes of rs7543472 under the allele model, homogenous model and recessive model; genotypes of rs11260867 under the heterogenous model and dominant model were associated with ARC risk. CONCLUSIONS: OGG1 rs1052133 (CG and CG+GG genotypes) might be risk factor for ARC, particularly in cortical cataract risk. EPHA2 rs7543472 (T allele and TT genotype) and rs11260867 (CG and GG+CG genotypes) might be associated with cortical cataract.

Global Teleophthalmology With the Smartphone for Microscopic Ocular Surgery.

PURPOSE: This study aimed to determine the feasibility and quality of real-time video transferring in global teleophthalmology using two smartphones during microscopic ocular surgery. METHODS: An iPhone 4S (Apple) was adapted into a surgical microscope in Hangzhou, Zhejiang, China to capture video during microscopic ocular surgery. An iPhone 5 (Apple), an iPad2 (Apple), and a desktop computer were used as the receptor on the other side of the globe (Miami, FL). A standard resolution test card and the three surgeries of human eyes were captured. During the global video teleconferencing, the real-time video was transferred through Skype from Hangzhou to Miami. A standard resolution test card and the surgery of human eyes were captured. The real-time image resolutions captured and displayed on both phones at different places were measured. Real-time vocal communications concurrent between two parties took place during video conferencing when the ocular surgery was performed in Hangzhou. RESULTS: The video sequences were transferred in real time between the two cities while two parties conversed smoothly without any difficulty. The viewer in Miami clearly visualized the surgical procedure performed in Hangzhou without lagging and distortion. The spatial resolution observed on the video in real time was similar for both phones. CONCLUSIONS: The study demonstrated that global video teleophthalmology for microscopic ocular surgery is feasible using two smartphones. The simple, portable, and affordable add-on attachment to the surgical microscope transfers high-quality video for real-time global teleophthalmology.

Age-related changes in the anterior segment biometry during accommodation.

PURPOSE: We investigated the dynamic response of human accommodative elements as a function of age during accommodation using synchronized spectral domain optical coherence tomography devices (SD-OCT). METHODS: We enrolled 33 left eyes from 33 healthy subjects (age range, 20-39 years, 17 males and 16 females). Two SD-OCT devices were synchronized to simultaneously image the anterior segment through pupil and the ciliary muscle during 6.00 diopter (D) accommodation for approximately 3.7 seconds in two repeated measurements. The anterior segment parameters included the lens thickness (LT), radius of curvature of the lens anterior surface (LAC), maximum thickness of ciliary muscle (CMTMAX), and anterior length of the ciliary muscle (CMAL). A first-order exponential equation was used to fit the dynamic changes during accommodation. The age-related changes in the dynamic response and their relationship were calculated and compared. RESULTS: The amplitude (r = -0.40 and 0.53 for LT and LAC, respectively) and peak velocity (r = -0.65 and 0.71 for LT and LAC, respectively) of the changes in LT and LAC significantly decreased with age (P < 0.05), whereas the parameters of the ciliary muscle remained unchanged (P > 0.05), except for the peak velocity of the CMAL (r = 0.44, P = 0.01). The difference in the time constant between the lens reshaping (LT and LAC) and CMTMAX increased with age (r = 0.46 and 0.57 for LT and LAC, respectively, P < 0.01). The changes in LT and LAC per millimeter of CMTMAX change decreased with age (r = -0.52 and -0.34, respectively, P < 0.05). The ciliary muscle forward movement correlated with the lens deformation (r = -0.35 and 0.40 for amplitude, while r = 0.36 and 0.58 for time constant, respectively, P < 0.05). CONCLUSIONS: Age-related changes in the lens reshaping and ciliary muscle forward movement were found. Lens reshaping was much slower than the contraction of the ciliary muscle, especially in aging eyes, and this process required the ciliary muscle to contract more to reach a given response.

Global teleophthalmology with iPhones for real-time slitlamp eye examination.

PURPOSE: To evaluate the image resolutions in global teleophthalmology using 2 smartphones. METHODS: A standard resolution test card and two human eyes (one eye wearing a contact lens) were imaged with an iPhone 4S adapted for slitlamp biomicroscopy in Hangzhou, Zhejiang, China. An iPhone 5 was used as a receptor on the other side of the world (Miami, FL). The real-time images and still images were transferred through Skype from Hangzhou to Miami during slitlamp eye examination. The real-time resolutions captured and displayed on the both phones at different places were measured. There was vocal communication concurrent between two parties during image transference and the examination by the slitlamp biomicroscopy performed in Hangzhou. RESULTS: The real-time and still images were transferred between two cities while two operators talked with each other smoothly and without difficulty. The viewer in Miami was able to instruct the operator in Hangzhou to thoroughly examine the eye using the slitlamp microscopy with different magnification settings and illumination settings. The resolution of the still images recorded in the iPhone in Hangzhou was higher than that of the real-time images on the screen. The main features of the eye were recognizable in real-time. CONCLUSIONS: The study demonstrated that global teleophthalmology is feasible using two smartphones. The system is simple, portable, and affordable, and the image quality in still and real-time images is acceptable for real-time teleophthalmology.

Whole eye axial biometry during accommodation using ultra-long scan depth optical coherence tomography.

PURPOSE: To investigate changes of whole eye axial biometry during accommodation using ultra-long scan depth optical coherence tomography (UL-OCT). DESIGN: Prospective, observational case series. METHODS: Twenty-one adult subjects were enrolled. Using UL-OCT, the left eye of each subject was imaged with relaxed diopters (0 D) and accommodative stimuli (+6 D). Full eye biometry included central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness, vitreous length, and axial length (AL). RESULTS: During accommodation (+6 D), the axial biometry of the whole eye changed significantly. Compared to the rest state, ACD at the accommodative state decreased significantly from 3.128 ± 0.305 mm to 2.961 ± 0.298 mm (paired t test, P < .001). The lens thickness increased significantly from 3.723 ± 0.237 mm to 3.963 ± 0.234 mm (P < .001). The vitreous length decreased significantly from 17.129 ± 0.864 mm to 17.057 ± 0.848 mm (P < .001). AL was 24.519 ± 0.917 mm at the rest state and increased to 24.545 ± 0.915 mm with +6 D accommodation stimulus. The elongated AL of 26.1 ± 13.4 µm between the rest and accommodative states was significant (P < .001). CONCLUSIONS: During accommodation, whole eye axial biometry changed, including a decrease in ACD and vitreous length and an increase in lens thickness and AL. UL-OCT provides an alternative method that is suitable for full eye biometry during accommodation.

Functional slit lamp biomicroscopy for imaging bulbar conjunctival microvasculature in contact lens wearers.

PURPOSE: To develop, test and validate functional slit lamp biomicroscopy (FSLB) for generating non-invasive bulbar conjunctival microvascular perfusion maps (nMPMs) and assessing morphometry and hemodynamics. METHODS: FSLB was adapted from a traditional slit-lamp microscope by attaching a digital camera to image the bulbar conjunctiva to create nMPMs and measure venular blood flow hemodynamics. High definition images with a large field of view were obtained on the temporal bulbar conjunctiva for creating nMPMs. A high imaging rate of 60 frames per second and an ~210× high magnification were achieved using the camera inherited high speed setting and Movie Crop Function, for imaging hemodynamics. Custom software was developed to segment bulbar conjunctival nMPMs for further fractal analysis and quantitatively measure blood vessel diameter, blood flow velocity and flow rate. Six human subjects were imaged before and after 6h of wearing contact lenses. Monofractal and multifractal analyses were performed to quantify fractality of the nMPMs. RESULTS: The mean bulbar conjunctival vessel diameter was 18.8 ± 2.7 µm at baseline and increased to 19.6 ± 2.4 µm after 6h of lens wear (P=0.020). The blood flow velocity was increased from 0.60 ± 0.12 mm/s to 0.88 ± 0.21 mm/s (P=0.001). The blood flow rate was also increased from 129.8 ± 59.9 pl/s to 207.2 ± 81.3 pl/s (P=0.001). Bulbar conjunctival nMPMs showed the intricate details of the bulbar conjunctival microvascular network. At baseline, fractal dimension was 1.63 ± 0.05 and 1.71 ± 0.03 analyzed by monofractal and multifractal analyses, respectively. Significant increases in fractal dimensions were found after 6h of lens wear (P<0.05). CONCLUSIONS: Microvascular network's fractality, morphometry and hemodynamics of the human bulbar conjunctiva can be measured easily and reliably using FSLB. The alternations of the fractal dimensions, morphometry and hemodynamics during contact lens wear may indicate ocular microvascular responses to contact lens wear.

Axial biometry of the entire eye using ultra-long scan depth optical coherence tomography.

PURPOSE: To assess the repeatability of axial biometry of the entire eye using ultra-long scan depth optical coherence tomography (OCT) and to investigate the agreement with IOLMaster measurements (Carl Zeiss Meditec). DESIGN: Prospective, observational case series. METHODS: There were 37 adult subjects enrolled in group 1 and 12 adult subjects enrolled in group 2. Using ultra-long scan depth OCT, the left eyes of these groups were measured in 2 separate sessions. The images were processed by a manual method and custom-developed automatic software. A model eye was imaged for verification. The subjects in group 2 were imaged using ultra-long scan depth OCT and using the IOLMaster for axial length measurement comparison. RESULTS: All measured parameters of the model eye matched the geometric parameters. In group 1, there were no significant differences in all measured parameters using automatic and manual segmentation methods (P > .05, paired t test). The percentage of coefficient of repeatability of segments ranged from 0.3% to 3.9%. The corresponding interclass correlation coefficients ranged from 0.946 to 0.999. The correlation between the results using automatic and manual segmentation methods appeared to be strong (R(2) = 0.999; P < .05). In group 2, the axial length of the eye measured by the IOLMaster matched the results obtained by ultra-long scan depth OCT with the automatic method (R1(2) = 0.987; P < .05) and the manual method (R2(2) = 0.988; P < .05). CONCLUSIONS: Automatic axial biometry using ultra-long scan depth OCT successfully measured each segment of the entire eye with good repeatability. With further development of automatic segmentation, ultra-long scan depth OCT seems to be a promising tool in the axial biometry of the entire eye.

Ultra-high resolution and long scan depth optical coherence tomography with full-phase detection for imaging the ocular surface.

We used a unique combination of four state-of-the-art technologies to achieve a high performance spectral domain optical coherence tomography system suitable for imaging the entire ocular surface. An ultra-high resolution, extended depth range, full-phase interferometry, and high-speed complementary metal-oxide semiconductor transistor camera detection provided unprecedented performance for the precise quantification of a wide range of the ocular surface. We demonstrated the feasibility of this approach by obtaining high-speed and high-resolution images of a model eye beyond the corneal-scleral junction. Surfaces determined from the images with a segmentation algorithm demonstrated excellent accuracy and precision.

Versatile optical coherence tomography for imaging the human eye.

We demonstrated the feasibility of a CMOS-based spectral domain OCT (SD-OCT) for versatile ophthalmic applications of imaging the corneal epithelium, limbus, ocular surface, contact lens, crystalline lens, retina, and full eye in vivo. The system was based on a single spectrometer and an alternating reference arm with four mirrors. A galvanometer scanner was used to switch the reference beam among the four mirrors, depending on the imaging application. An axial resolution of 7.7 µm in air, a scan depth of up to 37.7 mm in air, and a scan speed of up to 70,000 A-lines per second were achieved. The approach has the capability to provide high-resolution imaging of the corneal epithelium, contact lens, ocular surface, and tear meniscus. Using two reference mirrors, the zero delay lines were alternatively placed on the front cornea or on the back lens. The entire ocular anterior segment was imaged by registering and overlapping the two images. The full eye through the pupil was measured when the reference arm was switched among the four reference mirrors. After mounting a 60 D lens in the sample arm, this SD-OCT was used to image the retina, including the macula and optical nerve head. This system demonstrates versatility and simplicity for multi-purpose ophthalmic applications.

Simultaneous real-time imaging of the ocular anterior segment including the ciliary muscle during accommodation.

We demonstrated a novel approach of imaging the anterior segment including the ciliary muscle using combined and synchronized two spectral domain optical coherence tomography devices (SD-OCT). In one SD-OCT, a Complementary Metal-Oxide-Semiconductor Transistor (CMOS) camera and an alternating reference arm was used to image the anterior segment from the cornea to the lens. Another SD-OCT for imaging the ciliary muscle was equipped with a light source with a center wavelength of 1,310 nm and a bandwidth of 75 nm. Repeated measurements were performed under relaxed and 4.00 D accommodative stimulus states in six eyes from 6 subjects. We also imaged dynamic changes in the anterior segment in one eye during accommodation. The biometry of the anterior segment and the ciliary muscle was obtained. The combined system appeared to be capable to simultaneously real-time image the biometry of the anterior segment, including the ciliary muscle, in vivo during accommodation.

Resolution of slit-lamp microscopy photography using various cameras.

PURPOSE: To evaluate the resolutions of slit-lamp microscopy photography using various cameras. DESIGN: Evaluation of diagnostic test or technology. PARTICIPANTS: Healthy subjects were imaged with these adapted cameras through slit-lamp microscopy. METHODS: A total of 8 cameras, including 6 custom-mounted slit-lamp cameras and 2 commercial slit-lamp cameras, were tested with standard slit-lamp microscopy devices for imaging of the eye. Various magnifications were used during imaging. A standard resolution test plate was used to test the resolutions at different magnifications. These outcomes were compared with commercial slit-lamp cameras. MAIN OUTCOME MEASURES: The main measurements included the display spatial resolutions, image spatial resolutions, and ocular resolutions. The outcome also includes the relationships between resolution and the pixel density of the displays and images. RESULTS: All cameras were successfully adapted to the slit-lamp microscopy, and high-quality ocular images were obtained. Differences in the display spatial resolutions were found among cameras [analysis of variance (ANOVA), P<0.05]. Higher display resolutions were found with cameras using the high-definition multimedia interface (HDMI) compared with others, including cameras in smart phones. The display resolutions of smart phone displays were greater than cameras with video graphics array displays. The display spatial resolutions were found as a function of display pixel density (r>0.95, P<0.05) and magnification (r>0.85, P<0.05). Different image spatial resolutions were found among cameras (ANOVA, P<0.05) as a function of image pixel density (r>0.98, P<0.05) and magnification (r>0.85, P<0.05). The commercial slitlamp with a single lens reflex camera yielded the highest image spatial resolution. However, the ocular resolution through binocular viewing of the slit-lamp microscopy was found to have the highest resolution compared with the display and image spatial resolutions of all of the cameras. CONCLUSIONS: Several cameras can be adapted with slit-lamp microscopy for ophthalmic imaging, yielding various display and image spatial resolutions. However, the resolution seemed to not be as good as ocular viewing through the slit-lamp biomicroscope.