Head trauma can cause transient elevation of intraocular pressure in patients with open angle glaucoma

AIM: To describe a newly-recognized entity, illustrated by five cases of glaucoma in whom trauma to the head, but not the eye, resulted in marked, transient elevation of intraocular pressure (IOP). METHODS: Retrospective case series. Chart review. RESULTS: All five cases had a diagnosis of primary open-angle glaucoma prior to the experience of trauma to the head. All cases had an unusual elevation of IOP (around 70 percent) for days to weeks following the trauma, after which the IOP fell to pre-accident levels. No cause other than the trauma could be determined. CONCLUSION: The relationship between head trauma and elevation of IOP appears real.

Characteristics and visual outcomes of patients hospitalized for ocular trauma in central China: 2006-2011

AIM: To complete the data of ocular trauma in central China, as a well-known tertiary referral center for ocular trauma, we documented the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in this region.METHODS: A retrospective study of patients hospitalized for ocular trauma in central China from 2006 to 2011 was performed.· RESULTS: This study included 5964 eyes of 5799 patients. The average age was 35.5 ±21.8y with a male-to-female ratio of 2.8:1. The most common age was 45-59 y age group. Most patients were farmers and workers(51.9%). The most common injuries were firework related(24.5%), road traffic related(24.2%), and work related(15.0%). Among the most common causative agents were firecrackers(24.5%), followed by metal/knife/scissors(21.4%). Most injuries occurred in January(14.2%),February(27.0%), and August(10.0%). There were 8.5%patients with ocular injuries combined with other injuries.The incidence of open ocular injuries(4585 eyes, 76.9%)was higher than closed ocular injuries(939 eyes, 15.7%).The incidences of chemical and thermal ocular injuries were 1.2% and 0.6%. Ocular trauma score(OTS)predicted final visual acuity at non light perception(NLP), 20/200-20/50 and 20/40 with a sensitivity of 100%,and light perception(LP) /hand motion(HM) and 1/200-19/200 with a specificity of 100%.· CONCLUSION: This study provides recent epidemiological data of patients hospitalized for ocular trauma in central China. Some factors influencing the visual outcome include time interval between injury and visit to the clinic, wound location, open or closed globe injury, initial visual acuity, and OTS.

Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system

AIMTo determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS.METHODSA prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome.RESULTSThere were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P<0.005).CONCLUSIONReliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.

Predictive value and applicability of ocular trauma scores and pediatric ocular trauma scores in pediatric globe injuries

AIM: To evaluate the predictive value and applicability of Ocular Trauma Score(OTS) and Pediatric Ocular Trauma Score(POTS) for closed and open globe injuries in the pediatric group.METHODS: A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted.Medical records were collected,and injuries were classified using Birmingham Eye Trauma Terminology System(BETTS).The predictive value and applicability of both OTS and POTS to final visual acuity(VA) were analyzed.RESULTS: Of 84 patients,59(70.2%) presented with closed globe injuries(CGI) and 25(29.8%) with open globe injuries(OGI).The mean of initial VA was 0.832±0.904 log MAR.OTS and POTS was calculated.Initial VA(P<0.001) and traumatic cataract(P<0.001) were significantly associated with visual outcome,followed by organic/unclean wound (P=0.001),delay of surger y(P=0.001),iris prolapse(P=0.003),and globe rupture(P=0.008).A strong correlation between OTS and POTS and final VA(r=-0.798,P<0.001;r=-0.612,P<0.001) was found.OTS was more applicable in all age group of pediatric and in contrast to POTS,it was designed for 0-15 years old.POTS requires eleven parameters and OTS six parameters.Even though initial VA was not available,we could still calculate into POTS equation.CONCLUSION: OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI's in children.

Ocular trauma treated with pars plana vitrectomy: early outcome report

AIM： To evaluate demographic variables and visual outcomes, among patients with ocular injuries involving the posterior segment, managed with pars plana vitrectomy.· METHODS： The records of patients were studied retrospectively from March to September 2010, to determine the age, gender, place of occurrence of trauma, visual acuity, anatomical site, nature of injury,wound length, the presence of an afferent pupillary defect, and the timing of vitrectomy. The Ocular Trauma Score was measured. The minimum follow-up from presentation was 6mo.·RESULTS： Ninety patients（77 males, 13 females）, with a mean age of 32.7 ±15.8y were included over the 6-month period. The majority of cases occurred in the workplace（47 patients）, followed by home（14 patients）.The mean visual acuity（log MAR） of patients significantly improved from 2.36 ±0.72 preoperatively to 1.50 ±1.14 postoperatively. Twenty-three patients had preoperative vision better than 2.0 log MAR, the postoperative visual acuity was significantly better among these patients than patients with worse than 2.0 log MAR（P 〈0.001）. Visual improvement between groups with early vitrectomy（〉7d）and delayed vitrectomy（〉7d） was not significantly different（P =0.66）. Postoperative visual acuity was not significantly different between patients with injury in Zone I and II（P =0.64）, but patients with injury in Zone III had significantly poorer visual acuity（P =0.02）. Patients with relative afferent pupillary defect had significantly poorer postoperative visual acuity（P =0.02）. Preoperative visual acuity, the difference of preoperative and postoperative visual acuity, and postoperative visualacuity were significantly different between groups with different ocular trauma scores（P〈 0.001）.·CONCLUSION： Trauma is more likely to occur in men under 40 y of age and in the workplace. The favorable final visual outcome is associated with the absence of afferent pupillary defect, ocular trauma score and presenting visual acuity as well as the zone of injury, and not associated with the timing of vitrectomy.

Clinical relevance of the glucocorticoid receptor gene polymorphisms in glucocorticoid-induced ocular hypertension and primary open angle glaucoma

AIM: To avoid the side effects of ocular hypertension of glucocorticoid(GC) usage in eye, we must identify susceptible individuals, which exists in about one-third of all population. Further, the majority of all primary open angle glaucoma(POAG) patients show this phenotype.Glucocorticoid receptor(GR) regulates C responsiveness in trabecular meshwork(TM) cells. In this study, single nucleotide polymorphism(SNP) genotyping was used to determine whether there are differences in the Bcl I(rs41423247) and N363S(rs6195) polymorphisms of the GR gene in healthy and POAG patients, and glucocorticoid-induced ocular hypertension(GIOH)populations.METHODS: Three hundred and twenty-seven unrelated Chinese adults, including 111 normal controls, 117 GIOH subjects and 99 POAG patients, were recruited. DNA samples were prepared and the Bcl I and N363 S polymorphisms were screened using real-time polymerase chain reaction(RT-PCR)-restriction fragment length polymorphism(RFLP) analysis. Frequencies of the Bcl I and N363 S polymorphisms were determined and compared using Fisher’s exact test and the Chi-squared test.RESULTS: Only the Bcl I polymorphism was identified in the Chinese Han population. The frequency of the G allele was 21.6 % in normal controls, 18.3% in GIOH patients, and 13.64% in the POAG patients. There was no significant difference in polymorphism or allele frequency in the 3 groups. Furthermore, no N363 S polymorphism was found in the study subjects.CONCLUSION: The Bcl I polymorphisms in GR gene had no association with GIOH and POAG patients, and N363 S polymorphism might not exist in the Chinese Han population. Therefore, the Bcl I polymorphism might not be responsible for the development of GC-induced ocular hypertension or POAG.

Ocular Trauma in a Rural Population of North China:The Handan Eye Study

Objective To determine the prevalence of ocular trauma and the proportion of blindness and visua impairment due to trauma in a rural population in northern China. Methods The Handan Eye Study is a population-based cross-sectional study that surveyed 6830 Chinese people aged 30＋ years from 13 randomly selected villages in Yongnian County, city of Handan, Hebei Province, in July, 2006. All participants underwent a standardized interview and extensive examinations. A structured questionnaire was used to collect information on ocular trauma. Results Of the 5837 participants who filled out the questionnaire, 124 subjects [2.1%; 95% confidence interval （CI）, 1.8%-2.5%] reported a history of ocular trauma in either eye, including 19 （0.3%） persons reporting trauma in both eyes. Men were more likely to have an eye injury than women [odds ratio （OR）, 3.3; 2.2-4.9]. In multiple logistic regression models, ocular trauma was significantly more frequent among normotensive participants when compared with hypertensive participants （hypertensive vs. normotensive＂ OR, 0.6; 0.4-0.9） and among participants who had a history of falls （OR, 2.4; 1.2-4.8）. The proportion of unilateral visual impairment and unilateral blindness due to trauma were 10.5% （13 subjects） and 21.0% （26 subjects）, respectively. Conclusion Our study reports the prevalence of severe ocular trauma among adults in rural China, revealing a high proportion of blindness and visual impairment due to trauma. These findings suggest the need for educational strategies to increase eye health awareness in this rural population with focus on providing at least appropriate first aid care to reduce blindness due to trauma.

Ultrasound biomicroscopic evaluation of anterior segment cysts as a risk factor for ocular hypertension and closure angle glaucoma

AIMTo investigate the relationship between the ultrasound biomicroscopic (UBM) features of anterior-segment cysts (ASCs) and increased intraocular pressure (IOP) as a risk factor for closed-angle glaucoma (CAG).

Optical coherence tomography angiography of the peripapillary region and macula in normal,primary open angle glaucoma,pseudoexfoliation glaucoma and ocular hypertension eyes

AIM:To evaluate and compare the peripapillary and retinal vasculature changes in primary open angle glaucoma(POAG),pseudoexfoliation glaucoma(PXG),ocular hypertension(OHT)and normal eyes using optical coherence tomography angiography(OCTA).METHODS:A total of 114 POAG,PXG and OHT eyes of 60 patients and 46 eyes of 23 healthy control participants with good quality OCTA images were included.The PXG,POAG,OHT,and control groups(aged 68.17±6.30 y,61.11±10.26 y,58.1±8.9 y,and 56.9±4.6 y,respectively)contained of 46,36,32,and 46 eyes,respectively.Measurements of vessel density(VD)in the peripapillary region and macula,average retinal inner thickness,and retinal nerve fiber layer thickness(RNFLT)were compared among groups.In order to test the accuracy of differentiation between eyes with and without glaucoma,the area was calculated under the receiver operating characteristic(ROC)curves.RESULTS:The VD in glaucomatous eyes was significantly lower than the control group in all peripapillary sectors(44.35%±6.78%vs 50.47%±1.83%,P<0.001),the superficial(44.08%±5.46%vs 51.28%±2.85%,P<0.001)and the deep(45.13%±8.55%vs 54.20%±5.44%,P<0.001)vascular plexus.There was a significant difference in peripapillary VD between glaucomatous and OHT eyes(44.35%±6.78%vs 49.86%±2.45%,P<0.001).The OHT group featured a lower superficial(48.06%±4.32%vs 51.28%±2.85%,P=0.027)and deep plexus(48.70%±5.99%vs 54.20%±5.44%,P=0.013)whole image vessel density(wiVD)than did the control group.The average macular superficial plexus wiVD was significantly lower in eyes with PXG than in eyes with POAG(42.22%±5.36%vs 46.54%±5.56%,P=0.046).CONCLUSION:OCTA can measure reduced peripapillary and macular VD in eyes with glaucoma and OHT,and these results are correlated to functional and structural glaucomatous alterations.Peripapillary and macular superficial plexus VD is lower in eyes with PXG than in eyes with POAG.Furthermore,the OHT eyes demonstrate impaired macular vasculature in both superficial and deep plexus.

Fixed combination of latanoprost and timolol vs the individual components for primary open angle glaucoma and ocular hypertension:a systematic review and meta-analysis

AIM:To assess the effects of the fixed combination of0.005% latanoprost and 0.5% timolol(FCLT) vs their individual components for primary open angle glaucoma(POAG) and ocular hypertension(OHT).· METHODS:After searched PubMed, EMBASE, the Cochrane Library and SCI, all randomized controlled clinical trials(RCTs) and cross-over studies were included. The control groups were the monotherapy or the concomitant therapy of latanoprost and timolol. The outcomes were visual field defect, optic atrophy, mean intraocular pressure(IOP) and IOP fluctuation. The analysis was carried out in RevMan version 5.1 software.RESULTS:Thepost-interventionmeanIOPofFCLTwas significantly lower compared to timolol [mean difference(MD)-2.92, 95%CI-3.28 to-2.55, P 【0.00001] and latanoprost(MD-1.11, 95%CI-1.51 to-0.72, P 【0.00001). The postintervention IOP fluctuation was also significantly lower compared to timolol(MD-0.88, 95%CI-1.23 to-0.53, P 【0. 00001) and latanoprost( MD- 0. 63, 95 % CI- 1. 04to-0.22, P =0.002). The mean IOP was higher in FCLT morning dose group than the one in unfixed combination of 0.005% latanoprost and 0.5% timolol(UFCLT)(MD1.10, 95% CI 0.81 to 1.39, P 【0.00001). Otherwise, there was no difference between FCLT evening dose group and UFCLT(MD 0.34, 95% CI-0.01 to 0.69, P =0.06).There was no statistical difference for the incidence ofvisual field defect and optic atrophy between FCLT and the monotherapy of components.CONCLUSION:A better IOP lowering effect has been demonstrated for FCLT compared to the monotherapy of components. The IOP lowering effect was worse for FCLT morning dose and almost same for FCLT evening dose compared to the UFCLT. We need more long-term high quality RCTs to demonstrate the outcomes of visual field defect and optic atrophy.visual field defect and optic atrophy between FCLT and the monotherapy of components.CONCLUSION:A better IOP lowering effect has been demonstrated for FCLT compared to the monotherapy of components. The IOP lowering effect was worse for FCLT morning dose and almost same for FCLT evening dose compared to the UFCLT. We need more long-term high quality RCTs to demonstrate the outcomes of visual field defect and optic atrophy.

Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury

AIM: To elucidate the question of whether the ocular trauma score(OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment(RD) in patients with open globe injury(OGI).METHODS: A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS: Totally 102 patients with traumatic OGI with a minimum of 12 mo follow-up and a median age at of 48.6 y(range: 3-104 y) were identified. Final best corrected visual acuity(BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score Ⅰ(P<0.0001) or Ⅱ(P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >Ⅲ. OGI associated RD was observed in 36/102 patients(35.3%), whereas post traumatic RD(defined as RD following 14 d after OGI) occurred in 37 patients(36.3%). OGI associated RD did not correlate with the OTS and the zone of injury(P=0.193), yet post traumatic RD correlated significantly with zone Ⅲ injuries(P=0.013). CONCLUSION: The study shows a significant association between lower OTS score and zone Ⅲ injury with lower final BCVA and a higher number of surgeries, but only zone Ⅲ could be significantly associated with a higher rate of RD.

Application of pediatric ocular trauma score in pediatric open globe injuries

AIM:To evaluate the predictive value of pediatric penetrating ocular trauma score(POTS)on the visual outcome in children with open globe injury.METHODS:A retrospective study in 90 children(60 males and 30 females)aged 1-15 y(average,7.48±2.86 y)with penetrating ocular trauma was performed.Each patient’s POTS was calculated.The effects of POTS on final visual acuity(FVA)were examined.Correlation between factors affecting POTS and the FVA was established.RESULTS:All patients presented with single-eye trauma.The follow-up time was 3-21 mo(average,10.23±3.54 mo).Among the 90 cases of penetrating wounds,71 eyes(78.89%)were injured in Zone I(wound involvement limited to the cornea,including the corneoscleral limbus),17 eyes(18.89%)were injured in Zone II(wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus),and 2 eyes(2.22%)were injured in Zone III(wound involvement posterior to the anterior 5 mm of the sclera).Analysis of POTS and FVA showed important correlation between them(r=0.414,P=0.000).Initial visual acuity(P=0.00),age(P=0.02),injury location(P=0.002),traumatic cataract(P=0.00),vitreous hemorrhage(P=0.027),retinal detachment(P=0.003),and endophthalmitis(P=0.03)were found to be statistically significant factors for the FVA outcome.CONCLUSION:Ocular trauma presents serious consequences and poor prognosis in children.The POTS may be a reliable prognostic tool in children with open globe injury.

Central retinal artery occlusion and traumatic optic neuropathy following blunt ocular trauma

Dear Editor,We are writing to present a case report of central retinal artery occlusion（CRAO）and traumatic optic neuropathy（TON）with immediate visual loss caused by blunt facial trauma with a soccer ball.CRAO is an ophthalmic emergency with an estimated incidence of 10 in 1 million.

Bimatoprost/timolol fixed combination(BTFC) in patients with primary open angle glaucoma or ocular hypertension in Greece

AIM：To evaluate the efficacy and tolerability of the fixed combination of bimatoprost 0.03%and timolol 0.5%（BTFC）in patients in Greece with primary open angle glaucoma（POAG）or ocular hypertension（OHT）whose previous therapy provided insufficient lowering of intraocular pressure（IOP）.·METHODS：A multicenter,prospective,open-label,non-interventional,observational study of the use of BTFC in clinical practice was conducted at 41 sites in Greece.The primary endpoint was the reduction in IOP from baseline at study end,approximately 12wk after initiation of BTFC therapy.·RESULTS：A total of 785 eligible patients were enrolled in the study and 97.6%completed the study.The mean±SD IOP reduction from baseline at 12wk after initiation of BTFC was 6.3±2.8 mm Hg（=764;〈0.001）.In patients（=680）who replaced their previous IOP-lowering monotherapy（a single drug,or a fixed combination of 2drugs in a single ophthalmic drop）with once-daily BTFC,the mean±SD IOP reduction from baseline at 12wk was 6.2±2.8 mm Hg（〈0.001）.IOP was reduced from baseline in 99.2%of patients,and 58.0%of patients reached or exceeded their target IOP.Substantial mean IOP reductions were observed regardless of the previous therapy.BTFC was well tolerated,with 96.0%of patients who completed the study rating the tolerability of BTFC as＂good＂or＂very good.＂Adverse events were reported in 8.3%of patients;only 0.6%of patients discontinued the study due to adverse events.·C ONCLUSION：In clinical practice in Greece,BTFC is well tolerated and effectively lower the IOP in patients with POAG or OHT who requires additional IOP lowering on their previous therapy.

Pediatric ocular trauma with pars plana vitrectomy in Southwest of China:clinical characteristics and outcomes

AIM:To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy.METHODS:Pediatric ocular trauma patients(aged 14 y or younger)who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively.Age,gender,mechanism of injury,final visual acuity(VA),and prognostic factors were analyzed.RESULTS:A total of 139 eyes in 139 pediatric patients were included in the study.The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1.There were 104(74.8%)open globe injuries and 35(25.2%)closed globe injuries.The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects(43.9%).After vitrectomy,116 patients had favorable anatomic outcome at the last follow-up,and 30 eyes(21.6%)achieved VA of 20/200 or better.Following univariate analysis,we found zone III injuries(P=0.021),poor initial VA(P=0.005),endophthalmitis(P=0.024),and recurrent retinal detachment(P<0.001)were poor prognostic factors for pediatric ocular trauma.After Logistic regression analysis,the poor initial VA(odds ratio:8.276,95%CI:1.597-42.897,P=0.012)and recurrent retinal detachment(odds ratio:6.455,95%CI:2.372-17.562,P<0.001)were significantly correlated with unfavorable vision outcome in pediatric ocular trauma.CONCLUSION:The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes,but VA improvement is not as good as anatomic outcomes.Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.

Establishment of a prediction tool for ocular trauma patients with machine learning algorithm

AIM:To predict final visual acuity and analyze significant factors influencing open globe injury prognosis.METHODS:Prediction models were built using a supervised classification algorithm from Microsoft Azure Machine Learning Studio.The best algorithm was selected to analyze the predicted final visual acuity.We retrospectively reviewed the data of 171 patients with open globe injury who visited the Pusan National University Hospital between January 2010 and July 2020.We then applied cross-validation,the permutation feature importance method,and the synthetic minority over-sampling technique to enhance tool performance.RESULTS:The two-class boosted decision tree model showed the best predictive performance.The accuracy,precision,recall,F1 score,and area under the receiver operating characteristic curve were 0.925,0.962,0.833,0.893,and 0.971,respectively.To increase the efficiency and efficacy of the prognostic tool,the top 14 features were finally selected using the permutation feature importance method:(listed in the order of importance)retinal detachment,location of laceration,initial visual acuity,iris damage,surgeon,past history,size of the scleral laceration,vitreous hemorrhage,trauma characteristics,age,corneal injury,primary diagnosis,wound location,and lid laceration.CONCLUSION:Here we devise a highly accurate model to predict the final visual acuity of patients with open globe injury.This tool is useful and easily accessible to doctors and patients,reducing the socioeconomic burden.With further multicenter verification using larger datasets and external validation,we expect this model to become useful worldwide.

Ocular trauma in an urban Spanish population:epidemiology and visual outcome

AIM:To describe epidemiological aspects,clinical findings,and visual results in eye trauma patients requiring urgent surgery at a tertiary hospital.METHODS:Retrospective review of adult patients requiring urgent surgery for trauma to the eyeball from January 2010 and April 2020.Data was collected relative to age,gender,mechanism of the injury,type of wound,initial and final visual acuity,number and type of surgeries carried out.Injuries were classed according to the Birmingham Eye Trauma Terminology(BETT)and the Ocular Trauma Score(OTS)categories.RESULTS:The survey included 92 eyes.Mean age was 54.76±22.18 y.The most frequent cause was domestic accidents(44.6%),followed by aggression(22.80%)and occupational accidents(17.4%).Trauma from aggression was more frequent in men(P=0.006)and accidents in the home more common in women(P=0.011).Patients over 65 y presented an odds ratio(OR)of 10.71 for suffering a domestic accident.Patients between 15-45 and 46-65 y were at higher risk of trauma from aggression(OR=17.52 and OR=10.94,respectively).As for the type of injury,63.04%were open-globe lesions,Zone II being the most frequently affected(27.2%).In Logistic regression analysis,old age(P=0.05)and retinal involvement(P=0.001)were found to be associated with higher rate of unfavourable visual outcome.CONCLUSION:The epidemiological aspects of eye trauma are highly dependent on the area of population studied.Domestic accidents are more relevant than workplace accidents in older urban areas with high socioeconomic status.A better knowledge of the epidemiological characteristics is useful for implementing specific prevention measures and appropriate treatment strategies.

Comparison of ocular axis and corneal diameter between entropion and non-entropion eyes in children with congenital glaucoma

BACKGROUND Children with congenital glaucoma are often accompanied by acquired epiblepharon in the lower eyelid,which causes entropion of the lower eyelid and damages the cornea.AIM To infer the possible causes of lower eyelid entropion by comparing the difference of ocular axis and corneal diameter between inverted and non-inverted ciliary eyes in children with congenital glaucoma.METHODS A total of 15 patients(11 males and 4 females)diagnosed with congenital glaucoma between July 2016 and January 2019 at Tongren Hospital were included.Five patients had bilateral glaucoma,and ten had unilateral glaucoma.Each patient had only one eye with lower eyelid entropion which is associated with congenital glaucoma.All the patients had no entropion in another eye.The clinical data were collected.Main outcome measures were the ocular axis and corneal diameter.RESULTS The average age of the 15 patients was 1.85±0.49 years.Paired t-test showed that the average ocular axis of congenital glaucoma eyes with lower eyelid entropion(24.86±3.44 mm)was significantly longer than that of congenital glaucoma eyes without lower eyelid entropion(20.79±1.34 mm;P<0.001).The average corneal diameter of congenital glaucoma eyes with lower eyelid entropion(13.61±0.88 mm)was also significantly greater than that of congenital glaucoma eyes without lower eyelid entropion(11.63±0.48;P<0.001).CONCLUSION The rapid growth of the ocular axis and corneal diameter may be the main cause of congenital glaucoma with acquired lower eyelid entropion.Therefore,children with poor control of intraocular pressure and excessive growth of ocular axis and corneal diameter must be observed for the existence of acquired epiblepharon.

Predicting visual acuity with machine learning in treated ocular trauma patients

AIM:To predict best-corrected visual acuity(BCVA)by machine learning in patients with ocular trauma who were treated for at least 6mo.METHODS:The internal dataset consisted of 850 patients with 1589 eyes and an average age of 44.29y.The initial visual acuity was 0.99 log MAR.The test dataset consisted of 60 patients with 100 eyes collected while the model was optimized.Four different machine-learning algorithms(Extreme Gradient Boosting,support vector regression,Bayesian ridge,and random forest regressor)were used to predict BCVA,and four algorithms(Extreme Gradient Boosting,support vector machine,logistic regression,and random forest classifier)were used to classify BCVA in patients with ocular trauma after treatment for 6mo or longer.Clinical features were obtained from outpatient records,and ocular parameters were extracted from optical coherence tomography images and fundus photographs.These features were put into different machine-learning models,and the obtained predicted values were compared with the actual BCVA values.The best-performing model and the best variable selected were further evaluated in the test dataset.RESULTS:There was a significant correlation between the predicted and actual values[all Pearson correlation coefficient(PCC)>0.6].Considering only the data from the traumatic group(group A)into account,the lowest mean absolute error(MAE)and root mean square error(RMSE)were 0.30 and 0.40 log MAR,respectively.In the traumatic and healthy groups(group B),the lowest MAE and RMSE were 0.20 and 0.33 log MAR,respectively.The sensitivity was always higher than the specificity in group A,in contrast to the results in group B.The classification accuracy and precision were above 0.80 in both groups.The MAE,RMSE,and PCC of the test dataset were 0.20,0.29,and 0.96,respectively.The sensitivity,precision,specificity,and accuracy of the test dataset were 0.83,0.92,0.95,and 0.90,respectively.CONCLUSION:Predicting BCVA using machine-learning models in patients with treated ocular trauma is accurate and helpful in the identification of visual dysfunction.

The Study of Relationships between the Damage of Visual Function and Hemorrheology, Ocular Rheography, as well as Other Related Factors in Patients with Primary Open Angle Glaucoma (POAG)

Researches of glaucoma visual function damage, hemorrheololgy, ocular rheography and other related multiplex factors, with computed multifactorial stepwise regresion analysis, indicate that the elevation of intraocular pressure (IOP) is not the only factor to induce visual impairment. POAG patients are shown to have markedly reduced diastolic purfussion pressure in ophthalmic artery, besides prolonged filling time of the retinal artery and vein, diminished erythrocyte deformability and increased platele...