NMI,POLR3G and APIP are the key molecules connecting glaucoma with high intraocular pressure:a clue for early diagnostic biomarker candidates

AIM:To understand the molecular connectivity between the intraocular pressure(IOP)and glaucoma which will provide possible clues for biomarker candidates.METHODS:The current study uncovers the important genes connecting IOP with the core functional modules of glaucoma.An integrated analysis was performed using glaucoma and IOP microarray datasets to screen for differentially expressed genes(DEGs)in both conditions.To the selected DEGs,the protein interaction network was constructed and dissected to determine the core functional clusters of glaucoma.For the clusters,the connectivity of IOP DEGs was determined.Further,enrichment analyses were performed to assess the functional annotation and potential pathways of the crucial clusters.RESULTS:The gene expression analysis of glaucoma and IOP with normal control showed that 408 DEGs(277 glaucoma and 131 IOP genes)were discovered from two GEO datasets.The 290 DEGs of glaucoma were extended to form a network containing 1495 proteins with 9462 edges.Using ClusterONE,the network was dissected to have 12 clusters.Among them,three clusters were linked with three IOP DEGs[N-Myc and STAT Interactor(NMI),POLR3G(RNA Polymerase Ⅲ Subunit G),and APAF1-interacting protein(APIP)].In the clusters,ontology analysis revealed that RNA processing and transport,p53 class mediators resulting in cell cycle arrest,cellular response to cytokine stimulus,regulation of phosphorylation,regulation of type Ⅰ interferon production,DNA deamination,and cellular response to hypoxia were significantly enriched to be implicated in the development of glaucoma.Finally,NMI,POLR3G,and APIP may have roles that were noticed altered in glaucoma and IOP conditions.CONCLUSION:Our findings could help to discover new potential biomarkers,elucidate the underlying pathophysiology,and identify new therapeutic targets for glaucoma.

Effectivity and safety of trifocal intraocular lenses and capsular tension rings implantation for cataract patients with axial high myopia

●AIM:To assess effectivity and safety of trifocal intraocular lenses(IOLs)and capsular tension rings in treating cataract patients with axial high myopia.●METHODS:A prospective nonrandomized controlled clinical trial was conducted.Totally 98 eyes(74 patients)who underwent femtosecond laser-assisted cataract surgery(FLACS)with trifocal IOLs were enrolled in the study and followed up for 2y after surgery:46 eyes(33 patients)with capsular tension ring implantation in the long axial lengths(AL)group(26<AL<29 mm)and 52 eyes(41 patients)in the normal AL group(22<AL<24.5 mm).Postoperative outcomes about effectivity and safety,including the subjective and objective visual quality,and postoperative complications were assessed.●RESULTS:Uncorrected distance visual acuity at 5 m and uncorrected intermediate visual acuity at 60 and 80 cm in the long AL group were significantly worse than those in the normal AL group at 3mo postoperatively(P<0.05).The differences in reading speed,spectacle independence and potential visual complaints between the two groups were not statistically significant(P>0.05).The dysfunctional lens index and total modulation transfer function(MTF)average height were similar between the two groups.The postoperative internal coma aberrations in the axial high myopia eyes were significantly higher than that in the normal AL group(P<0.05).The total satisfaction score in the long AL group(91.32±2.76)was slightly higher than that in the normal AL group(90.36±3.47),but there was no difference(P=0.136).A statistically negative correlation was found between corrected distance visual acuity(CDVA)and dysfunctional lens index(r=-0.382,P=0.009),and between CDVA and the total MTF average height(r=-0.374,P=0.01).But there was no significant correlation between CDVA and total satisfaction score(r=0.059,P=0.696).Postoperative complications mainly presented as posterior capsular opacity(PCO),retinal detachment and cystoid macular edema.There was no difference in the incidence of fundus disease(6.5%vs 3.8%,P=0.663)or PCO(17.4%vs 7.7%,P=0.217)between the two groups at two years.●CONCLUSION:The utilization of trifocal IOL and capsular tension ring implantation is beneficial for cataract patients with axial high myopia undergoing FLACS.This approach not only ensures excellent subjective feelings and objective visual quality,but also does not increase the incidence of postoperative complications.

Single-cell RNA sequencing analysis of the retina under acute high intraocular pressure

High intraocular pressure causes retinal ganglion cell injury in primary and secondary glaucoma diseases,yet the molecular landscape characteristics of retinal cells under high intraocular pressure remain unknown.Rat models of acute hypertension ocular pressure were established by injection of cross-linked hyaluronic acid hydrogel(Healaflow■).Single-cell RNA sequencing was then used to describe the cellular composition and molecular profile of the retina following high intraocular pressure.Our results identified a total of 12 cell types,namely retinal pigment epithelial cells,rod-photoreceptor cells,bipolar cells,Müller cells,microglia,cone-photoreceptor cells,retinal ganglion cells,endothelial cells,retinal progenitor cells,oligodendrocytes,pericytes,and fibroblasts.The single-cell RNA sequencing analysis of the retina under acute high intraocular pressure revealed obvious changes in the proportions of various retinal cells,with ganglion cells decreased by 23%.Hematoxylin and eosin staining and TUNEL staining confirmed the damage to retinal ganglion cells under high intraocular pressure.We extracted data from retinal ganglion cells and analyzed the retinal ganglion cell cluster with the most distinct expression.We found upregulation of the B3gat2 gene,which is associated with neuronal migration and adhesion,and downregulation of the Tsc22d gene,which participates in inhibition of inflammation.This study is the first to reveal molecular changes and intercellular interactions in the retina under high intraocular pressure.These data contribute to understanding of the molecular mechanism of retinal injury induced by high intraocular pressure and will benefit the development of novel therapies.

Clinical Effect Analysis of Posterior Chamber Intraocular Lens Implantation for Correcting High Myopia and Astigmatism

Objective:To explore the corrective effect of posterior chamber intraocular lens implantation with phakic eyes in the treatment of high myopia and astigmatism.Methods:From May 2023,the hospital began to collect the case data of diagnosis and treatment of high myopia and astigmatism.By May 2024,310 cases were included,all of which were treated with posterior chamber intraocular lens implantation.The visual acuity,astigmatism and axial position of the intraocular lens were observed before and after treatment.Results:At different time points after the operation,the patient’s vision was significantly improved compared with that before the operation(P<0.05),and the vision level was equal to or greater than the best-corrected vision before the operation.At different time points after the operation,the average rotation of the intraocular lens was less than 5 degrees.Astigmatism was significantly lower than that before the operation(P<0.05).After the operation,the intraocular pressure increased in 11 cases,accounting for 3.55%,with no adverse complications such as lens turbidity,glare and obvious halo occurring.Conclusion:The posterior chamber intraocular lens implantation with phakic eyes has an ideal correction effect in the treatment of high myopia and astigmatism,which can effectively improve the vision level of patients and reduce the degree of astigmatism,and has high effectiveness and safety.

Long-term vision-threatening complications of phakic intraocular lens implantation for high myopia

AIMTo report the long-term vision-threatening complications in patients who underwent phakic intraocular lens (pIOLs) implantation for high myopia.

Effect of lens constants optimization on the accuracy of intraocular lens power calculation formulas for highly myopic eyes

AIM: To evaluate the effect of different lens constant optimization methods on the accuracy of intraocular lens(IOL) power calculation formulas for highly myopic eyes.METHODS: This study comprised 108 eyes of 94 consecutive patients with axial length(AL) over 26 mm undergoing phacoemulsification and implantation of a Rayner(Hove, UK) 920H IOL. Formulas were evaluated using the following lens constants: manufacturer’s lens constant, User Group for Laser Interference Biometry(ULIB) constant, and optimized constant for long eyes. Results were compared with Barrett Universal II formula, original Wang-Koch AL adjustment method, and modified Wang-Koch AL adjustment method. The outcomes assessed were mean absolute error(MAE) and percentage of eyes with IOL prediction errors within ±0.25, ±0.50, and ±1.0 diopter(D). The nonparametric method, Friedman test, was used to compare MAE performance among constants.RESULTS: Optimized constants could significantly reduce the MAE of SRK/T, Hoffer Q, and Holladay 1 formulas compared with manufacturer’s lens constant, whereas the percentage of eyes with IOL prediction errors within ±0.25, ±0.50, and ±1.0 D had no statistically significant differences. Optimized lens constant for long eyes alone showed non-significant refractive advantages over the ULIB constant. Barrett Universal II formula and formulas with AL adjustment showed significantly higher accuracy in highly myopic eyes(P<0.001). CONCLUSION: Lens constant optimization for the subset of long eyes reduces the refractive error only to a limited extent for highly myopic eyes.

AcrySof phakic angle-supported intraocular lens for the correction of high to extremely high myopia:one-year follow-up results

AIM: To assess the safety, efficacy and predictability of the AcrySof phakic angle-supported intraocular lens (IOL) (Alcon Inc., U.S.A.) for correction of high-to-extremely high myopia in adults. METHODS: In this prospective study performed in Tianjin Medical University Eye Center & College of Optometry, Tianjin, China, 25 eyes of 13 patients were implanted with AcrySof phakic angle-supported IOLs and followed for 1 year postoperatively. Preoperative manifest refractive sphere was (-12.08 +/- 2.44) diopters (D) and cylinder was (-1.35 +/- 0.62)D. Visual acuity, predictability and stability of manifest refraction spherical equivalent (MRSE), adverse events, and endothelial cell density were analyzed during 1-year of follow-up. RESULTS: After 1 year of follow-up, no eyes lost 1 line (best spectacle-corrected visual acuity)BSCVA; an uncorrected visual acuity (UCVA) of 20/20 or better was achieved in 60% of eyes; 100% had an UCVA of 20/40 or better; a BSCVA of 20/30 or better was achieved by 100% of eyes; 84% had a BSCVA of 20/20 or better. The overall mean percentage change in endothelial cell density 1 year after surgery was (-0.27 +/- 3.60)%. Two eyes (8%) had increased intraocular pressure (IOP) on the day of surgery. No pupil ovalization, pupillary block, or retinal detachment events were observed. CONCLUSION: After 1 year of follow-up, the implantation of AcrySof phakic angle-supported IOL is proved to be safe, effective and predictable with minimal complications in patients with high-to-extremely high myopia. Due to the limitation of visiting time, long-term of clinical investigation is necessary to verify the safety and efficacy of this IOL.

Short and long-term outcomes of angle supported phakic intraocular lens implantation in high myopic eyes

This cohort study included 36 eyes of 21 patients with high myopia treated with angle supported phakic intraocular lens（p IOL）.Endothelial cell density（ECD） at baseline,6 mo and 3 y were 3017±296,2775±265 and 2558±299 cells/mm^2 respectively.ECD loss at 6 mo was 7.2% and annual ECD loss was 3% over 36 mo.Corrected distance visual acuity at 36 mo was 0.4 log MAR or better in 32（88.9%） eyes.Intraocular pressure did not change（P=0.9）.No eyes developed cataract,retinal detachment or pupillary distortion.Angle supported p IOL gives good visual outcome.Endothelial cell loss should be monitored.

Long-term results of clear lens extraction combined with piggyback intraocular lens implantation to correct high hyperopia

AIM:To assess the refractive outcome of clear lensectomy combined with piggyback intraocular lens implantation in highly hyperopic patients.METHODS:This case review included 19 eyes of 10 patients with high hyperopia and axial length less than 21mm.Intraocular lens power was calculated for emmetropia using the Holladay II formula in 17 eyes,and SRK/T formula in 2 eyes following clear lens extraction and piggyback intraocular lens implantation.Patients were examined periodically over 24 months for visual acuity and spherical equivalent(SE).RESULTS:The mean postoperative SE at 24 months was 0.20±1.39D(range,-3.00 to 2.50D),better than preoperative 9.81±2.62D(range,+6.00 to +14.50D)(P【0.001).Five eyes had SE within±0.5D of emmetropia and 11 eyes within±1.00D at postoperative 24 months.The mean postoperative uncorrected visual acuity(UCVA) at 24 months was 0.60±0.36,significantly improved compared to preoperative 1.39±0.33(P【0.001).The mean best-corrected visual acuity(BCVA) at 24 months was 0.49±0.35,not statistically different compared to preoperative 0.38±0.30(P=0.34).Twelve eyes maintained and 1 gained 1 or more Snellen line of BCVA,4 eyes lost 1 line,and 2 eyes lost 2 lines at 24 postoperative months.Twelve eyes best-corrected near visual acuity (BCNVA) achieved J1 at postoperative 24 months compared to preoperative 7 eyes and the other 7 eyes better than J3.CONCLUSION:Clearlensextractioncombinedpiggyback intraocular lens implantation appears to be an effective procedure to correct high hyperopia but mild overcorrection and intralenticular opacification may require secondary procedure.

Inflammatory myofibroblastic tumor diagnosed due to high intraocular pressure

Dear Editor,I am writing this letter to present an unusual case of orbital inflammatory myofibroblastic tumor(IMT)diagnosed due to high intraocular pressure(IOP).IMT is a rare mesenchymal,low-grade malignant or borderline tumor,composed of differentiated myofibroblastic spindle cells,often accompanied by plasma cells and lymphocyte infiltration[1].The onset in most patients is insidious.

Protective limb remote ischemic post-conditioning against high-intraocular-pressure-induced retinal injury in mice

AIM: To determine whether limb remote ischemic postconditioning(LRIC) protects against high-intraocularpressure(IOP)-induced retinal injur y, and to identify underlying molecular mechanisms. METHODS: In mice, IOP was increased to 110 mm Hg for 50 min and LRIC applied to the unilateral leg for three occlusion cycles(5 min/release). Three animal groups(control, high IOP, and high IOP+LRIC) were arranged in this study. Plasma was collected from LRIC treated mice. Retinal histology, oxidative stress were determined by histological section staining and chemical kit. C/EBP homologous protein(CHOP), and Iba-1 parameters were evaluated by immunofluorescent staining and Western blot. RESULTS: The data showed that LRIC treatment alleviated the retinal histological disorganization and ganglion cell loss induced by high IOP. The CHOP, Iba-1 expression and oxidative stress marker also were inhibited by LRIC treatment. To further explore underlying mechanisms, plasma from LRIC treated animals was intravenously transfused into high-IOP animals. The results showed plasma injection decreased caspase 9 expression and DHE staining signals compared with that in high IOP retinas. CONCLUSION: These data suggest that LRIC treatments exert retinal protective effects against high-IOP injury.Endogenous humoral factors release into the circulation by LRIC may contribute to homeostatic protection by reducing monocyte infiltration and/or microglia activation.

Comparison of Visual Quality after Implantation of Big Bag and Akreos Adapt Intraocular Lenses in Patients with High Myopia

Purpose: To compare vision quality following phacoemulsification cataract extraction and implantation of a Big Bag or Akreos Adapt intraocular lens(IOL) in patients diagnosed with high myopia complicated with cataract.Methods:.This was a randomized prospective control study.The patients with high myopia complicated with cataract, with axial length ≥28 mm,.and corneal astigmatism ≤1D were enrolled and randomly divided into the Big Bag and Akreos Adapt IOL groups. All patients underwent phacoemulsification cataract extraction and lens implantation..At 3 months after surgery,.intraocular high-order aberration was measured by a Tracey-i Trace wavefront aberrometer at a pupil diameter of 5mm in an absolutely dark room and statistically compared between two groups. The images of the anterior segment of eyes were photographed with a Scheimpflug camera using Pentacam three-dimensional anterior segment analyzer..The tilt and decentration of the IOL were calculated by Image-pro plus 6.0imaging analysis software and statistically compared between two groups.Results:.In total,.127 patients(127 eyes),..including 52 males and 75 females, were enrolled in this study. The total high-order aberration and coma in the Akreos Adapt group(59 eyes)were significantly higher compared with those in the Big Bag(P <0.05)..The clover and spherical aberration did not differ between the two groups(P>0.05). The horizontal and vertical decentration were significantly smaller in the Big Bag lens group than in the Akreos Adapt group(both P<0.05), whereas the tilt of IOL did not significantly differ between the two groups(P>0.05).Conclusion:.Both Big Bag and Akreos Adapt IOLs possess relatively good intraocular stability implanted in patients with high myopia. Compared with the Akreos Adapt IOL, the Big Bag IOL presents with smaller intraocular high-order aberration. Coma is the major difference between the two groups.

Effect of Qingguang'anⅡon expressions of OX42 protein and IL-1βmRNA of retinal microglia cells of rats with chronic high intraocular pressure

The study investigated the effects of Qingguang＇an Ⅱ（a Chinese medicinal preparation） on expressions of OX42 protein and interleukin-1β（IL-1β） mRNA of retinal microglia cells of rats with chronic high intraocular pressure（IOP）. SD rats were randomly divided into 6 groups, that were： A： blank group; B： model group; C： Qingguang＇an Ⅱ low dose group; D： Qingguang＇an Ⅱ medium dose group; E： Qingguang＇an Ⅱ high dose group; F： Yimaikang disket（a Chinese medicinal preparation） group. Experimental rats in B, C, D, E, F groups were established the model of chronic high IOP by cauterizing of superficial scleral vein. Tissues of eyes were obtained after intragastric administration for 2 and 4 wk. At the time-point of 2 wk, OX42 protein and IL-1β mRNA in group B were statistically expressed in higher level comparing with other groups（P〈0.05）. Moreover, at the time-point of 4 wk, OX42 protein and IL-1β mRNA in groups C, D and E were statistically expressed in lower level comparing with group F（P〈0.05）. Besides, OX42 protein and IL-1β mRNA in groups C and D were statistically expressed in higher level comparing with group E（P〈0.05）. OX42 protein and IL-1β mRNA in groups C and D were expressed in similar level（P〉0.05）. The study indicated that, in the protection of optic nerve of rats with chronic high IOP, the high dose of Qingguang＇an Ⅱ at the time-point of 4 wk was the better choice.

Dynamic changes of inducible nitric oxide synthase expression in rat's retina and its role on blood-retinal barrier injury after acute high intraocular pressure

AIM: To clarify the role of inducible nitric oxide synthase(i NOS) in blood-retinal barrier(BRB) injury after acute high intraocular pressure(IOP) in rats.METHODS: Forty-two Sprague-Dawley(SD) rats were randomized into 7 groups [control(Cont), 3, 6, 12, 24, 48, and 72 h, n=6]. Except Cont group, other groups’ retina tissue was obtained at corresponding time points after a model of acute high IOP have been established in rats. The expression of i NOS and tight junction protein zonula occludens(ZO)-1 was detected by Western blotting. Evans blue(EB;3%) was injected into the great saphenous vein to detect the leakage of EB by spectrophotometer. Nine rats were divided into Cont, 6 h, 12 h groups, the expression of i NOS was localized by immunofluorescence. In order to verify the role of i NOS in the damage to BRB, thirty-six rats were randomly divided into 4 groups [Cont, Cont+inhibitor(Inh), 6 h and 6 h+Inh, n=9]. After treatment with the i NOSspecific inhibitor 1400 W, the expression of i NOS and ZO-1 and the leakage of BRB were detected again.RESULTS: The immunofluorescence results showed that the expression of i NOS was observed in the Cont group and 6 h group, but not in the 12 h group. i NOS was mainly expressed in the retinal nerve fiber layer, ganglion cell layer and inner nuclear layer and that it did not colocalize with the retinal ganglion cell marker Neu N but was co-expressed with the vascular endothelial cell marker CD31. Western blotting showed that in the early period(3 h, 6 h) after acute high IOP, the expression of i NOS was upregulated, then the down-regulation of i NOS were tested in the follow-up timing spots. ZO-1 expression showed a continuous downregulation after 6 h. The quantitative results for EB showed that the amount of EB leakage began to increase at 3 h after acute high IOP. At 6 h, the leakage of EB was lower, but at 12 h, the leakage of EB was highest, after which it gradually recovered but remained higher than that in the Cont group. The expression of i NOS was down-regulated after 1400 W treatment. ZO-1 expression was not significantly changed in the Cont+Inh group and the 6 h group, and significantly down-regulated in the 6 h+Inh group, and the leakage of EB was significantly increased after 1400 W treatment.CONCLUSION: These results suggest that the upregulation of i NOS expression in the early stage after acute high IOP may have a protective effect on BRB injury.

Bioinformatics analysis of potential essential genes that response to the high intraocular pressure on astrocyte due to glaucoma

AIM: To study the gene expression response and predict the network in cell due to pressure effects on optic nerve injury of glaucoma.METHODS: We used glaucoma related microarray data in public database [Gene Expression Omnibus(GEO)] to explore the potential gene expression changes as well as correspondent biological process alterations due to increased pressure in astrocytes during glaucoma development.RESULTS: A total of six genes were identified to be related with pressure increasing. Through the annotation and network analysis, we found these genes might be involved in cell morphological remodeling, angiogenesis,mismatch repair.CONCLUSION: Increasing pressure in glaucoma on astrocytes might cause gene expression alterations,which might induce some cellular responses changes.

TrkB and p-trkB expression in brain-derived neurotrophic factor-pretreated rat retina following acute high intraocular pressure

BACKGROUND： Exogenous brain-derived neurotrophic factor （BDNF） promotes retinal ganglion cell survival. However, the protective mechanisms remain unclear. OBJECTIVE： To investigate changes in retinal tyrosine kinase receptor B （trkB） expression and effects of exogenous BDNF on trkB activation in a rat model of acute high intraocular pressure （HtOP）. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment was performed at the Department of Anatomy and Neurobiology, Xiangya Medical School, Central South University from January 2004 to August 2006. MATERIALS： Rabbit anti-BDNF and anti-trkB.FL（full-length） polyclonal antibodies were purchased from Santa Cruz Biotechnology, USA; rabbit anti-p-trkB polyclonal antibodies were purchased from Cellsignal, USA. METHODS： A total of 48 healthy, adult, Sprague Dawiey rats were randomly assigned to acute HIOP （without BDNF pre-treatment） and BDNF pre-treated groups, with 24 animals in each group. In the BDNF pre-treated group, the left eyes were intravitreally injected with 3 pg/kg BDNF 2 days prior to HIOP. Rats in the acute HIOP group were not pre-treated with BDNE HIOP models were established by increased intraocular pressure in the left eyes until the b-wave of flash electroretinogragh disappeared and pressure was maintained for 60 minutes. The right eyes of all rats were not treated and served as the normal controls. MAIN OUTCOME MEASURES： Retinal structure and cell numbers in the ganglion cell layer （GCL） were detected by Nissl staining; expression of trkB and phosphorylated trkB in the rat retina were determined by immunohistochemistry. RESULTS： A greater number of GCL neurons were observed in the pre-treated group compared to the acute HIOP group （P 〈 0.05）. TrkB expression was significantly increased following HIOP at days 1 and 3 （P 〈 0.05）, but expression varied between retinal areas. Although trkB expression decreased at 7 days, phosphorylated trkB dramatically decreased with increasing time （P 〈 0.05）. TrkB expression in BDNF pre-treated rats was similar to the acute HIOP group at early injury time points. Nevertheless, trkB expression was significantly decreased compared to the acute HIOP group at 7 days （P 〈 0.05）, and phosphorylated trkB expression was significantly greater compared to the acute HIOP group at each time point （P〈 0.05）. CONCLUSION： TrkB expression displayed temporal and spatial changes in the rat retina following acute HIOP, and trkB up-regulation suggested that more BDNF was required for treating the injured retina. Exogenous BDNF partially ameliorated decreased expression of phosphorylated trkB and provided protection to the injured retina, to a certain degree, following HIOP.

Does high intraocular pressure exclude an open globe injury?

Dear Sir,Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable diagnostic and management strategies for open-globe injuries[1].Amongst many types of ocular trauma,the open globe injury is the most serious due to its very poor visual prognosis and young population of patients are mostly affected[2].The treatment outcome may be improved by prompt diagnosis,and immediate surgical repair performed to high standard[3].Amongst the other clinical signs the intraocular pressure(IOP)is found to be particularly reduced and conventionally this is considered as a very reliable indicator of occult globe

Vascular endothelial growth factor-165b protects the blood-retinal barrier from damage after acute high intraocular pressure in rats

AIM:To elucidate the role of vascular endothelial growth factor-165b(VEGF-165b)in blood-retinal barrier(BRB)injury in the rat acute glaucoma model.METHODS:In this study,the rat acute high intraocular pressure(HIOP)model was established before and after intravitreous injection of anti-VEGF-165b antibody.The expression of VEGF-165b and zonula occludens-1(ZO-1)in rat retina was detected by double immunofluorescence staining and Western blotting,and the breakdown of BRB was detected by Evans blue(EB)dye.RESULTS:The intact retina of rats expressed VEGF-165b and ZO-1 protein,which were mainly located in the retinal ganglion cell layer and the inner nuclear layer and were both co-expressed with vascular endothelial cell markers CD31.After acute HIOP,the expression of VEGF-165b was up-regulated;the expression of ZO-1 was down-regulated at 12h and then recovered at 3d;EB leakage increased,peaking at 12h.After intravitreous injection of anti-VEGF-165b antibody,the expression of VEGF-165b protein was no significantly changed;and the down-regulation of the expression of ZO-1 was more obvious;EB leakage became more serious,peaking at 3d.EB analysis also showed that EB leakage in the peripheral retina was greater than that in the central retina.CONCLUSION:The endogenous VEGF-165b protein may protect the BRB from acute HIOP by regulating the expression of ZO-1.The differential destruction of BRB after acute HIOP may be related to the selective loss of retinal ganglion cells.

Case report:simultaneous femtosecond laser astigmatic keratotomy and toric intraocular lens implantation in femtosecond laser-assisted cataract surgery in a patient with surgically induced high corneal astigmatism

Background:Femtosecond laser astigmatic keratotomy(FSAK)and toric intraocular lens(IOL)implantation have been studied individually for comparison to treat astigmatism at cataract surgery.We report a case of surgically induced high corneal astigmatism by laser thermal keratoplasty(LTK)in a patient with cataract who was successfully treated with simultaneous combination of FSAK and toric IOL implantation with femtosecond laser-assisted cataract surgery(FLACS).This is the first report of both procedures combined simultaneously,with or without history of LTK.Case Description:A 68-year-old male presented with a history of LTK with two enhancements each eye in 2004,with subsequent surgically induced high corneal astigmatism,and with age-related nuclear cataract of both eyes.IOL master demonstrated+7.71 diopters of astigmatism at 163 degree right eye and+3.29 diopters of astigmatism at 4 degree left eye.After extensive discussion of the risks and benefits,the patient agreed to undergo FLACS with FSAK with two 61 degrees of relaxation incisions(RIs)and toric IOL(Alcon SN6AT9)right eye;FLACS with toric IOL(Alcon SN6AT7)alone left eye.At 2-year follow-up,uncorrected visual acuity was 20/30 right eye,20/25 left eye.His best corrected visual acuity was 20/25(+0.25+1.00 axis 21)right eye and 20/20(plano+0.25 axis 90)left eye;his best corrected near visual acuity was J1+with add+2.50 diopters right eye and left eye.Conclusions:Patients with age-related cataract and LTK induced high corneal astigmatism can hardly be sufficiently treated with FSAK or toric IOL alone at the time of cataract surgery.An effective way is to combine large FSAK and toric IOL of the highest cylindrical power of T9,in our case,simultaneously,which can achieve an excellent long term visual outcome.

Effect of High-Order Aberrations and Satisfaction on Cataract Patients Implanted with Four Types of AcrySof Blue Light Filtering Intraocular Lens

Objective: The objective is to evaluate the visual acuity, high-order aberrations and satisfaction in the cataract patients with the implantation of different types of AcrySof blue light filtering intraocular lens, which would provide the clinical guidance for the selection of individualized intraocular lens. Methods: From January 2019 to December 2020, the patients with age-related cataract in Guangzhou Red Cross Hospital were equally randomized to be divided into four groups. 20 patients (20 eyes) were implanted with AcrySof (SN60WF), which was the blue light filtering single focus group;20 patients (20 eyes) were implanted with blue light filtering aspheric multifocal intraocular lens (AcrySof ReSTOR IOL +3.0D, SN6AD1), which was the multifocal intraocular lens group;20 patients (20 eyes) were implanted with aspheric astigmatism correction intraocular lens (Toric SN6AT), which was the astigmatism group;20 patients (20 eyes) were implanted with blue filtering aspheric multifocal astigmatism correction intraocular lens (AcrySof ReSTOR IOL +2.5D IQ, SV25T0), which was the ART group. Three months after the operation, the patients were followed up with slit lamp to check the visual acuity, including uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best corrected distance visual acuity, (BCDVA);the questionnaire surveys on the satisfaction of different intraocular lens implantation (far and near vision, glare, halo and abnormal visual symptoms);the iTrace visual function analyzer was used to check the total high-order aberrations (spherical aberration, wisdom aberration and Clover aberration) in the 3 mm pupil diameter. Results: Three months after cataract surgery, American Simplified version of questionnaire survey showed that the scores of near removing glasses in the multifocal group and the ART group were significantly better than those in the single focus group and the astigmatism group (P < 0.05);there was no significant difference in the satisfaction of far removing glasses, glare and halo in each group (P > 0.05). Three months after cataract surgery, there were statistically significant differences about UCDVA, BCDVA and UCNVA among the four groups (F = 18.189, P < 0.001), the UCNVA in the multifocal group and ART group was significantly better than that in the single focus group and the astigmatism group (P < 0.01). The difference of higher-order aberrations (total higher-order aberrations, wisdom aberrations, spherical aberrations, clover aberrations) was no statistically significant among the four groups (P > 0.05). Conclusion: Different types of AcrySof blue light filtering intraocular lens implantation could improve the far vision and satisfaction of cataract patients, without different higher-order aberrations. Multifocal intraocular lens and ART intraocular lens could significantly improve the far vision of patients and reduce the dependence on near glasses.