Stromal lenticule addition keratoplasty with corneal crosslinking for corneal ectasia secondary to FS-LASIK:a case series

●AIM:To explore the clinical efficacy and safety of stromal lenticule addition keratoplasty(SLAK)with corneal crosslinking(CXL)on patients with corneal ectasia secondary to femtosecond laser-assisted in situ keratomileusis(FS-LASIK).●METHODS:A series of 5 patients undertaking SLAK with CXL for the treatment of corneal ectasia secondary to FS-LASIK were followed for 4-9mo.The lenticules were collected from patients undertaking small incision lenticule extraction(SMILE)for the correction of myopia.Adding a stromal lenticule was aimed at improving the corneal thickness for the safe application of crosslinking and compensating for the thin cornea to improve its mechanical strength.●RESULTS:All surgeries were conducted successfully with no significant complications.Their best corrected visual acuity(BCVA)ranged from 0.05 to 0.8-2 before surgery.The pre-operational total corneal thickness ranged from 345-404μm and maximum keratometry(Kmax)ranged from 50.8 to 86.3.After the combination surgery,both the corneal keratometry(range 55.9 to 92.8)and total corneal thickness(range 413-482μm)significantly increased.Four out of 5 patients had improvement of corneal biomechanical parameters(reflected by stiffness parameter A1 in Corvis ST).However,3 patients showed decreased BCVA after surgery due to the development of irregular astigmatism and transient haze.Despite the onset of corneal edema right after SLAK,the corneal topography and thickness generally stabilized after 3mo.●CONCLUSION:SLAK with CXL is a potentially beneficial and safe therapy for advanced corneal ectasia.Future work needs to address the poor predictability of corneal refractometry and compare the outcomes of different surgical modes.

有晶状体眼后房型人工晶状体植入术后患者干眼情况

目的:研究有晶状体眼后房型人工晶状体(ICL)植入术后患者干眼相关的临床变化,评价其眼表疾病的严重程度。方法:前瞻性研究。纳入2019-09/10拟行ICL植入手术矫正近视的患者50例50眼。分别于术前,术后1wk,1、3mo时进行眼表疾病指数(OSDI)问卷评分和角膜染色评分(Oxford法)、泪膜破裂时间(TBUT)、基础泪液分泌量(SⅠt)、下睑中央泪河高度检查。结果:OSDI问卷评分在术后1wk,1mo时较术前明显增加(P<0.05),至术后3mo恢复至术前水平,角膜染色评分在术后3mo基本恢复至术前水平,术后3mo与术后1wk比较有差异(χ^(2)=5.267,P=0.022)。角膜染色评分在各个时间点均和OSDI问卷评分呈显著的正相关(rs>0,P<0.05)。TBUT在术后1wk及1mo较术前明显降低(P<0.05),术后3mo恢复至术前水平。SⅠt和下睑中央泪河高度在术后各个时间点与术前相比无差异(P>0.05)。结论:ICL植入术后早期会影响患者眼表泪膜的稳定性,使患者出现不同程度的干眼相关症状,OSDI问卷评分可以评价其主观不适症状。但到术后3mo,患者眼表泪膜稳定性恢复至术前水平。角膜染色阳性评分越高的患者,干眼相关症状越明显。

原发性急性闭角型青光眼患者房水中CXCR2和bFGF表达与小梁切除术后预后的关系

目的:探讨原发性急性闭角型青光眼(APACG)患者的房水中趋化因子受体2(CXCR2)、碱性成纤维细胞生长因子(bFGF)水平与小梁切除术后预后的关系。方法:收集2020-06/2022-01期间本院收治的80例80眼行小梁切除术的APACG患者纳入病例组,依据术后疗效分为成功组60例60眼和失败组20例20眼;收集同期本院行白内障超声乳化术且眼压正常的白内障患者86例86眼纳入对照组。采用酶联免疫吸附法检测房水中CXCR2、bFGF水平;采用ROC曲线分析房水中CXCR2、bFGF水平预测APACG患者小梁切除术失败的价值;APACG患者小梁切除术失败的影响因素采用多因素Logistic回归分析。结果:病例组房水中CXCR2、bFGF水平显著高于对照组(P<0.05)。失败组房水中CXCR2、bFGF水平及术后浅前房发生患者比例显著高于成功组(P<0.05)。房水中CXCR2、bFGF水平单独及联合预测APACG患者小梁切除术后失败的AUC分别为0.885、0.883、0.953。CXCR2、bFGF是APACG患者小梁切除术后失败的危险因素(P<0.05)。结论:APACG患者房水中CXCR2、bFGF水平显著升高,且二者均是小梁切除术后失败的危险因素。

Retinoblastoma: concerning its initiation and treatment

·Retinoblastoma (RB) is the most common intraocular cancer of infancy and childhood. This cancer is initiated by mutation on , the tumor suppressor gene that is responsible for the regulation of both cell cycle and gnome stability in retinal cells. Patients with a constitutional mutation on can be inherited. RB occurs approximately 1 in every 15 000-20 000 live births. The worldwide mortality for this cancer is about 5%-11%. However, this rate rises to about 40%-70% in developing countries due to a delay in diagnosis. A wide variety of options are available for the treatment, but often a combination of therapies is adopted to optimize individualized care. ·

Androgen and meibomian gland dysfunction:from basic molecular biology to clinical applications

Meibomian gland,the largest sebaceous gland of the body,is responsible for the biosynthesis of lipid layer of the tear film to prevent excessive evaporation.The loss of normal functions of meibomian gland,known as meibomian gland dysfunction(MGD),is a chronic disease and is the leading cause of dry eye symptoms in the clinics.Studies have found sex hormones,especially androgen,play vital roles in the regulation of the functions of meibomian gland.Recently,androgen has also been preliminarily applied in clinics for the treatment of MGD and showed promising results,especially in people with endogenous androgen deficiency.This review summarized the mechanisms of the function of androgen on meibomian gland based on molecular,animal,and clinical studies,and proposed evidence-based views about its potential applications for the treatment of MGD.

Comparisons of morphologic characteristics between thin-flap LASIK and SBK

AIM: To compare the morphologic characteristics between thin-flap laser in situkeratomileusis (LASIK) and Sub-Bowman keratomileusis (SBK), and to evaluate the uniformity of flap and to explore the correlative factors of corneal flap thickness. METHODS: A prospective, randomized, comparative clinical study was performed in Department of Ophthalmology, West Hospital of China, Chengdu, Sichuan Province, China. Totally 59 patients 114 eyes underwent LASIK or SBK to correct myopia, 29 patients 57 eyes underwent SBK, 30 patients 57 eyes underwent LASIK. Anterior optical coherence tomography (OCT) was used to measure corneal flap thickness in all the patients 1 week after surgeries, 16 positions were set to be measured in each eye. Comparisons of flap thickness in each group and between 2 groups were evaluated. Correlative factors of flap thickness were evaluated. RESULTS: Coefficient of variation(CV, s/((X) over bar)x%)in SBK group were lesser than that in LASIK group, ttest showed there was significant statistical difference between 2 groups (P=0.000). Comparisons of the difference of 2 paired positions (temporal-nasal; superior-inferior) showed there were no significant differences in each group, but between 2 groups, there were statistical significance of value of difference (D-value) of superior and inferior positions between SBK and LASIK group (P =0.036). Linear regression analysis of correlative factors of flap thickness showed there were no statistic significances related to central corneal thickness(CCT) (P =0.060, t=1.921)and corneal curvature( P=0.083, t=1.766). CONCLUSION: SBK is better than LASIK in a-eating much uniform corneal flap. There was no evidence showing correlations between flap thickness and CCT or corneal curvature.

A 3-month comparison study of subjective and objective visual quality of small incision lenticule extraction and transepithelial photorefractive keratectomy in patients with low and moderate myopia

AIM:To compare the subjective and objective visual quality between small incision lenticule extraction(SMILE)and transepithelial photorefractive keratectomy(t PRK)in patients with low and moderate myopia.METHODS:Patients undertaking SMILE or t PRK for the correction of low and moderate myopia were consecutively recruited in this prospective cohort study with a 3-month follow-up period.Objective evaluation[visual acuity test,manifest refraction,wavefront aberrations,the total cut-off value of the total modulation transfer function(MTFcut-off),and Strehl ratio(SR)]and subjective evaluation of visual quality(quality-of-life questionnaire)were conducted before surgery and at days 1,7,30,and 90 after surgery.RESULTS:A total of 47 patients(94 eyes)with SMILE and 22 patients(22 eyes)with t PRK were enrolled.The uncorrected visual acuity(UCVA)was better in SMILE patients on day 7 after surgery(1.13±0.13 vs 0.99±0.17,t=4.85,P<0.001)but was comparable at days 30 and 90.At day 90,the SMILE group had a lower spherical equivalent(SE)than the t PRK group(0.04±0.31 vs 0.19±0.43,t=2.08,P=0.042).Total higher order aberrations(HOAs)were induced in both surgical types,which were more evident in the t PRK group with 3-mm pupil diameter(0.16±0.07 vs0.11±0.05,t=4.27,P<0.001)and 5-mm pupil diameter(0.39±0.17 vs 0.36±0.11,t=2.33,P=0.022).The MTFcut-offand SR showed a trend of improvement in both SMILE and t PRK patients but were statistically better in the SMILE group with both pupil diameters.There was a significant improvement of contrast sensitivity(CS)over baseline levels at the spatial frequency of 18 cycles/degree(c/d)in the SMILE group(F=2.72,P=0.033)and at 3 c/d(F=3.03,P=0.031),12 c/d(F=3.72,P=0.013),and 18 c/d(F=4.62,P=0.004)in the t PRK group.The subjective quality of life questionnaire showed a steady improvement in the SMILE group(F=8.31,P<0.001)but not the t PRK group.CONCLUSION:SMILE and t PRK are both safe and effective ways to correct low and moderate myopia.A generally better and quicker recovery of visual quality favors the application of SMILE in qualified patients.

Effect of body position on the pathogenesis of asymmetric primary open angle glaucoma

AIM： To explore the pathogenesis of asymmetric primary open angle glaucoma（POAG） in both eyes by comparing the intraocular pressure（IOP） of patients who sleep in different positions and to investigate the relationship between IOP variations and sleep positions.METHODS： One hundred and thirty-one patients with asymmetric POAG and forty-six healthy volunteers were enrolled. All participants completed a questionnaire that provided information about their sleep laterality. The cup disc ratio（C/D） and visual field defect established binocular asymmetry. The IOP of both eyes was measured using i Care parameters after the patients were asked to change body position. The ＂worse＂ and ＂better＂ eyes were identified according to the diagnosis, whereas the ＂dependent＂ and ＂independent＂ eyes were defined according to the lateral position. RESULTS： No significant difference in sleep laterality was observed between healthy people and patients with POAG（F=3.195, P=0.362）. Among the enrolled patients, the IOP of the dependent eye was always greater than that of the independent eye in the lateral position（P〈0.05）. In the patients with binocular asymmetric POAG, the questionnaire clearly showed that 85.7% of left side preferences were found their left eyes to be the worse eyes and the right eyes of 71.4% patients with a right side preference were the more serious. When the asymmetric C/D ratio was greater than or equal to 0.2, the worse eye of patients with POAG and a preferred sleeping position was the dependent eye（χ~2=16.762, P=0.001）.CONCLUSION： A higher IOP was measured in the dependent eye in the lateral position. The long-term tendency to choose a lateral sleeping position might lead the dependent eye to manifest more severe symptoms than the independent eye. Thus, the lateral sleeping position might be one cause of asymmetric POAG.

Transgenic dry eye mouse models: powerful tools to study dry eye disease

Dry eye disease(DED) is one of the most common chronic multifactorial ocular surface diseases with high prevalence and complex pathogenesis. DED results in several ocular discomforts, vision fluctuation, and even potential damage of the ocular surface, bringing heavy burdens both on individuals and the society. The pathology of DED consists of tear film hyperosmolarity and immune responses on the ocular surface. Mice are widely used for developing models that simulate human DED features for investigating its pathogenesis and treatment. DED can be classified into aqueous-deficiency dry eye(ADDE) and evaporative dry eye(EDE). ADDE can be further divided into Sj?gren syndrome dry eye(SSDE) and non-Sj?gren syndrome dry eye(NSSDE). SSDE mouse models include natural strains, typified by non-obese diabetic(NOD) mice, and genetically engineered ones, like Aire-/-and Id3 knockout mice. Intrinsic EDE mainly refers to meibomian gland dysfunction(MGD). Eda-/-Tabby, Sod1-/-, Elovl1-/-are the most common transgenic MGD mouse models. Transgenic mouse models provide useful tools for studying the pathogenesis of DED and evaluating its novel therapies. This review compares the major transgenic dry eye mouse models and discusses their applications in DED research.

Comment on:Optic neuropathy and increased retinal glial fibrillary acidic protein due to microbead-induced ocular hypertension in the rabbit

Dear Editor,W e read with great interest the study by Zhao et al[1],which evaluated optic neuropathy and changes in the amount of glial fibrillary acidic protein in the retina with intracameral injection of microbeads into rabbits.The objective was to investigate whether the injection of microbeads into the anterior chamber can induce chronic intraocular hypertension in a glaucoma model in rabbits.