Bilateral meibomian gland morphological alterations in unilateral herpes simplex keratitis based on artificial intelligence analysis

AIM:To explore whether unilateral herpes simplex keratitis(HSK)can cause morphological changes of bilateral meibomian glands(MGs)based on artificial intelligence(AI)analytical system.METHODS:In the retrospective study,29 patients with unilateral HSK and 29 participants matched in terms of age and sex were included as control group.Meibographic images of the upper eyelid using Keratograph 5M and assessed ocular surface parameters including tear meniscus height and tear break-up time.MG density and vagueness values were automatically analyzed and calculated using an AI analytical system.We compared the differences between the affected and the contralateral unaffected eyes in HSK patients,and the normal control eyes.We employed either the paired t-test or the Wilcoxon signed-rank test to compare significant difference between the affected and unaffected eyes in HSK patients or between the HSK group and control group.RESULTS:The MG density was 0.19±0.09 in the HSKaffected eye and 0.18±0.07 in contralateral unaffected eye,which had no significant difference(P=0.616).The MG density between the affected eye with HSK and the normal control group was statistically significant(P=0.028).There was a significant difference in MG density between the contralateral unaffected eye and the normal control group(P=0.012).However,no significant difference in vagueness value was observed between the eye with HSK and the control group or between HSK eye and contralateral eye.CONCLUSION:The MG density between the HSKaffected eye and the contralateral unaffected eye don’t significantly differ,whereas there is a significant decrease in the HSK group compared to that of the normal participants.Unilateral HSV keratitis may suffer from bilateral changes of MG morphology indicating bilateral dry eye.Therefore,the fellow eye of patients with unilateral HSK should be considered a potential case of MG dysfunction,necessitating early treatment for bilateral dry eye in the clinic.

Macular and peripapillary retinal nerve fiber layer thickness in children with hyperopic anisometropic amblyopia

AIM:To compare the retinal nerve fiber layer (RNFL) thickness and macular thickness in the amblyopic eye with that in the sound eye of children with hyperopic anisometropic amblyopia using optical coherence tomography (OCT). METHODS:A prospective, nonrandom, intraindividual comparative cohort study includes 72 children with hyperopic anisometropic amblyopia in a single center. Macular thickness, macular foveola thickness, and peripapillary RNFL thickness were compared between the amblyopia eyes and the contralateral sound eyes. ·RESULTS:There were 38 male and 34 female patients, with a mean age as 9.7 ±1.9 years (range, 5-16 years). Hyperopic was +3.62±1.16D (range +2.00D to +6.50D) in the amblyopic eyes, which was significantly higher in the control eyes with +0.76±0.90D (range 0D to +2.00D) (P 【 0.01). The mean peripapillary RNFL thickness was 113.9± 7.2μm and 109.2 ±6.9μm in the amblyopic eye and the normal eye, respectively, reaching statistical significance (P = 0.02). The mean macular foveola thickness was significantly thicker in the amblyopic eyes than the contralateral sound eyes (181.4±14.2μm vs 175.2±13.3μm, P 【0.01), but the 1mm, 3mm or 6mm macular thickness central macular thickness was not significantly different. Degree of anisometropia in the contralateral eyes was not significantly correlated with differences of peripapillary RNFL, macular foveola thickness or central macular thickness. CONCLUSION:Eyes with hyperopic anisometropic amblyopia are found thicker macular foveola and peripapillary RNFL than the contralateral eyes in children.

Vitrectomy with residual internal limiting membrane covering and autologous blood for a secondary macular hole:A case report

BACKGROUND Myopic foveoschisis(MF)is a common complication of pathological myopia.A macular hole(MH)usually results from the natural progression of MF and is a common complication of vitrectomy.Vitrectomy combined with residual internal limiting membrane(ILM)covering and autologous blood was effective for closing a secondary MH.CASE SUMMARY A 52-year-old woman presented to our clinic with a complaint of blurred vision in the right eye for 7 years.Her best corrected visual acuity(BCVA)was 20/100,axial length was 25.79 mm and standard equivalent refractive error was-10.5 dioptres.Preoperative optical coherence tomography revealed foveoschisis in the right eye.Vitrectomy with fovea-sparing ILM peeling was performed.An MH developed and gradually expanded 5 mo after the initial vitrectomy.Vitrectomy with residual ILM covering and autologous blood was performed.The MH closed 3 wk after the second vitrectomy.CONCLUSION Fovea-sparing ILM peeling can provide residual ILM for the treatment of MH secondary to vitrectomy for MF.Vitrectomy combined with residual ILM covering and autologous blood is effective for closing secondary MH and improving BCVA.

Ethambutol-induced optic neuropathy with rare bilateral asymmetry onset:A case report

BACKGROUND Ethambutol-induced optic neuropathy(EON)most commonly manifests as bilateral symmetrical loss of vision and often cause serious and irreversible visual impairment because of the lack of early detection and effective treatment.We followed a case of EON with rare binocular asymmetric clinical manifestations and observed the changes of visual function and retinal structure after drug withdrawal,so as to further understand the clinical characteristics of this disease.CASE SUMMARY A 54-year-old man complained of gradual visual decline in the left eye.The patient presented with best-corrected visual acuity of 20/20 in the right eye and 20/50 in the left eye.Color vision examination revealed difficulty in reading green color plates in the left eye.The visual field manifested as concentric contraction in the left eye.After nearly a month of drug withdrawal,the right eye had a similar decline in visual function.At the last visit,19 mo after drug withdrawal,the visual function significantly recovered in both eyes.During follow-up optical coherence tomography(OCT)examination,both eyes manifested the thickness of the retinal nerve fiber layer from mild thickening to thinning and finally temporal atrophy,and the ganglion cell-inner plexiform layer showed significant thinning.The difference was that a reversible structural disorder in the outer retina of the nasal macula was detected in the left eye by macular high-definition OCT.CONCLUSION Nephropathy and high blood pressure,which damage the retinal microcirculation,may cause damage to the outer layer of the retina.Ethambutol may influence photoreceptor as well as retinal ganglion cells.

Bilateral retrocorneal hyaline scrolls secondary to asymptomatic congenital syphilis: A case report

BACKGROUND Retrocorneal hyaline scrolls are a rare phenomenon.We report a case of bilateral retrocorneal hyaline scrolls that were likely induced by asymptomatic congenital syphilis.CASE SUMMARY A 71-year-old woman presented with blurred vision due to cataracts.Slit-lamp microscopy revealed bilateral hyaline scrolls with a dichotomous branching pattern extending to the anterior chamber or rods attaching to the rough posterior surface of the cornea.The patient was positive for syphilis-specific antibodies,with no ocular or systemic evidence of congenital or acquired syphilis.Binocular cataract,retrocorneal scroll,and corneal endothelial gutta were considered.The scroll of the right eye was removed during cataract surgery and further observed using hematoxylin–eosin staining and scanning electron microscopy.The cornea of the right eye remained transparent,and the residual scroll seemed stable,however,the corneal endothelial density declined at 13 mo after surgery.In vivo confocal microscopy revealed coalescence of corneal guttae at the level of the corneal endothelium or adhesion to the posterior surface of the endothelium,with enlarged endothelial cells in both eyes.Activated keratocytes in the stroma and a highly reflective acellular structure at the level of the Descemet’s membrane were observed.The removed scroll had a cartilage-like hardness and a circularly arranged fiber-like acellular structure.CONCLUSION Occult congenital syphilis could induce corneal endothelial gutta and theformation of retrocorneal scrolls without other signs of ocular syphilis.

Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus

Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao's hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups. Results: A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P<0.001). There were no statistical differences in corneal sensitivity recovery or corneal re-innervation between the groups (P>0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006). Conclusions: Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.

Integrated phase unwrapping algorithm for the measurement of 3D shapes by Fourier transform profilometry

An integrated and reliable phase unwrapping algorithm is proposed based on residues and blocking-lines detection, closed contour extraction and quality map ordering for the measurement of 3D shapes by Fourier-transform profilometry (FTP). The proposed algorithm first detects the residues on the wrapped phase image, applies wavelet analysis to generate the blocking-lines that can just connect the residues of opposite polarity, then carries out the morphology operation to extract the closed contour of the shape, and finally uses the modulation intensity information and the Laplacian of Gaussian operation of the wrapped phase image as the quality map. The unwrapping process is completed from a region of high reliability to that of low reliability and the blocking-lines can prevent the phase error propagation effectively. Furthermore, by using the extracted closed contour to exclude the invalid areas from the phase unwrapping process, the algorithm becomes more efficient. The experiment shows the effec-tiveness of the new algorithm.