Transient vacuolar changes of the crystalline lens in patients using a dispersive ophthalmic viscosurgical device

AIM:To report the clinical prognosis and pathological findings of accidental lens vacuolar changes in eyes with intraoperative exposure to a dispersive ophthalmic viscosurgical device(OVD).METHODS:Two patients who developed transient lens vacuolar changes during uneventful persistent pupillary membrane(PPM)removal surgery were presented and followed up.This event was speculated to be associated with an intraoperative dispersive OVD DisCoVisc(hyaluronic acid 1.6%-chondroitin sulfate 4.0%)exposure.Then,to provide the pathological basis for our speculation,another four cataract patients were randomly exposed to different OVDs,and their anterior lens capsules were investigated with transmission electron microscopy(TEM).RESULTS:After months,the subcapsular vacuoles in both PPM cases were gradually disappeared without visual deterioration.For the cataract patients,similar lens changes were observed intraoperatively in those exposed to a dispersive DisCoVisc but not a cohesive OVD IVIZ(sodium hyaluronate gel 1.0%).In addition,marked ultrastructural changes,including chromatin condensation,extensive cytoplasmic vacuoles,and obvious intercellular space between lens epithelial cells in the anterior lens capsules of all eyes exposed to DisCoVisc,were observed by TEM.CONCLUSION:The lens vacuolar changes may be associated with a dispersive OVD exposure.Therefore,it is not preferable to use dispersive OVDs in patients with transparent lenses or without the intention of lens extraction.In addition,close follow-ups instead of immediate lens extraction are recommended for the occurrence of similar lens lesions.

Changes in crystalline lens parameters during accommodation evaluated using swept source anterior segment optical coherence tomography

Backgrounds:To assess changes in anterior segment biometry during accommodation using a swept source anterior segment optical coherence tomography(SS-OCT).Methods:One hundred-forty participants were consecutively recruited in the current study.Each participant underwent SS-OCT scanning at 0 and−3 diopter(D)accommodative stress after refractive compensation,and ocular parameters including anterior chamber depth(ACD),anterior and posterior lens curvature,lens thickness(LT)and lens diameter were recorded.Anterior segment length(ASL)was defined as ACD plus LT.Lens central point(LCP)was defined as ACD plus half of the LT.The accommodative response was calculated as changes in total optical power during accommodation.Results:Compared to non-accommodative status,ACD(2.952±0.402 vs.2.904±0.382 mm,P<0.001),anterior(10.771±1.801 vs.10.086±1.571 mm,P<0.001)and posterior lens curvature(5.894±0.435 vs.5.767±0.420 mm,P<0.001),lens diameter(9.829±0.338 vs.9.695±0.358 mm,P<0.001)and LCP(4.925±0.274 vs.4.900±0.259 mm,P=0.010)tended to decreased and LT thickened(9.829±0.338 vs.9.695±0.358 mm,P<0.001),while ASL(6.903±0.279 vs.6.898±0.268 mm,P=0.568)did not change significantly during accommodation.Younger age(β=0.029,95%CI:0.020 to 0.038,P<0.001)and larger anterior lens curvature(β=−0.071,95%CI:−0.138 to−0.003,P=0.040)were associated with accommodation induced greater steeping amplitude of anterior lens curvature.The optical eye power at 0 and−3 D accommodative stress was 62.486±2.284 and 63.274±2.290 D,respectively(P<0.001).Age was an independent factor of accommodative response(β=−0.027,95%CI:−0.038 to−0.016,P<0.001).Conclusions:During−3 D accommodative stress,the anterior and posterior lens curvature steepened,followed by thickened LT,fronted LCP and shallowed ACD.The accommodative response of−3 D stimulus is age-dependent.

Preoperative evaluation of human crystalline lens hardness using A-scan ultrasound biometry： a pilot study

Dear Editor,I write to present the results of a study on the correlation between the ultrasound energy consumed during phacoemulsification with various preoperative parameters,including best corrected distance visual acuity（BCDVA）,the signal to noise ratio（SNR）obtained by partial coherence laser interferometry and primarily,lens spikes measurements derived by A-scan ultrasound biometry.Quantification of crystalline lens hardness before cataract removal has been attempted by several researchers in the past.These have been in humans and in animals,in vivo and in vitro,and have used a variety of imaging modalities.

23-Gauge Pars Plana Vitrectomy Alone by a Bimanual Technique for the Removal of Dense Posteriorly Dislocated Crystalline Lens

Background: We sought to verify the efficacy and safety of transconjunctival 23-gauge pars plana vitrectomy (PPV) alone by our bimanual technique for the removal of dense posteriorly dislocated crystalline lens. Methods: A retrospective, noncomparative, interventional study of 31 consecutive cases of patients who underwent 23-gauge PPV alone for the removal of dense posteriorly dislocated crystalline lens following complicated cataract surgeries using our bimanual technique was conducted. The main outcomes measured included best-corrected visual acuity (BCVA), preoperative intraocular pressure (IOP), postoperative IOP and postoperative complications. Results: In all 31 cases included in this study, those dense posteriorly dislocated crystalline lenses were successfully removed. The enrolled patients consisted of 17 males and 14 females with a mean age of (75.84 ± 6.17) years (range 59 - 90). The mean follow-up length was (7.61 ± 1.87) months with a range of 6 months to 1 year. The mean preoperative BCVA was 0.22 ± 0.11 logMAR system, and the postoperative BCVA was 0.33 ± 0.07 logMAR system after 6 months of follow-up. The mean operative time was 46.32 ± 4.80 minutes with a range of 38.00 to 57.00 minutes. All of the conjunctival incisions self-closed within the first week with no wound leakage or hemorrhage. The postoperative complications were relatively rare. Conclusions: The removal of dense posteriorly dislocated crystalline lens might be a challenge for micro-incision vitrectomy. Our bimanual technique was proved to be an effective and safe method for those particular dense lenses using 23-gauge alone.

Sutured scleral fixation of existing subluxated/dislocated acrylic one-piece intraocular lenses

AIM:To evaluate the visual and refractive outcomes in cases after sutured scleral fixation of existing subluxated or dislocated acrylic one-piece intraocular lenses(IOLs).METHODS:This study retrospectively enrolled a consecutive series of patients who underwent a surgery of sutured existing subluxated or dislocated IOLs from October 2018 to June 2020.All patients underwent comprehensive preoperative and postoperative ophthalmologic examination,and data were collected including age,sex,surgical indications,best-corrected visual acuity,refractive error,intraocular pressure.Presence of intraoperative and postoperative surgical complications was documented.RESULTS:A total of 20 consecutive cases were enrolled for analysis with mean final follow-up period 9.8±5.3mo.Visual acuity improved from a mean of 0.35(0.46±0.32 logMAR)preoperatively to 0.61(0.21±0.18 logMAR)at the 3-month follow-up(P=0.002).The mean amount of preoperative keratometric astigmatism and total postoperative refractive astigmatism was-1.24±0.80 diopters(D)and-1.42±0.97 D,respectively.There was no statistically significant difference between preoperative and postoperative astigmatism(P=0.156).The mean IOL-induced astigmatism was-0.23±0.53 D.The mean spherical equivalent at the 3-month follow-up was-0.1±0.94 D.No major complications were noted during the follow-up period.CONCLUSION:Surgical techniques using sutured scleral fixation of existing subluxated or dislocated acrylic one-piece IOLs result in favorable visual and refractive outcomes without major complications.

Analysis of changes in crystalline lens thickness and its refractive power after laser in situ keratomileusis

AIM: To evaluate changes in the anterior chamber depth (ACD), crystalline lens thickness (LT) and its refractive power after laser in situ keratomileusis (LASIK). METHODS: In all cases, the preoperative and postoperative central ACD which were measured with Pentacam, Orbscan, IOL-Master and A-scan ultrasonography, central corneal true net power which was measured with the Pentacam, Orbscan and IOL-Master, axial length (AL) which was measured with IOL-Master and LT which was measured with the A-scan ultrasonography were compared using the paired sample t test. Ocular refractive errors and lens refractive power at corneal plane were calculated and their correlations were also evaluated before and after LASIK. RESULTS: At 1 week after LASIK, LT and crystalline lens refractive power at corneal plane (Dlens) which were associated with the IOL-Master and Pentacam increased significantly (P <= 0.005), ACD decreased significantly (P <= 0.001), but no significant increase was observed in the Diens which was associated with the Orbscan(P=0.261). Significant correlations between the changes in the ocular refractive errors and Diens which were associated with the Pentacam were observed at 1 week and 6 months after LASIK (P = 0.028; P=0.001). CONCLUSION: LT increased significantly after LASIK, and this might partially lead to ACD decrease, Diens increase and a small quantity of myopic regression.

Iatrogenic crystalline lens injury during intravitreal injection of triamcinolone acetonide: A report of two cases

BACKGROUND Intravitreal injection has become an efficient approach for delivering drugs at therapeutic levels to the posterior segment in retinal diseases.However,the increased frequency and number of intravitreal injections have raised concerns about their side effects.As manipulation during surgery is relatively simple,details of the procedure are easily overlooked.Iatrogenic crystalline lens injury is a rare complication caused by improper manipulation during surgical procedures.We report two cases of crystalline lens injury during intravitreal injection of triamcinolone acetonide(TA)with the hope of providing an insight into this treatment.CASE SUMMARY Case 1 was a 62-year-old woman with macular edema caused by central retinal vein occlusion in her right eye,and Case 2 was a 65-year-old man with macular edema caused by branch retinal vein occlusion in his right eye.In view of the patients’condition and economic constraints,an intravitreal injection of TA was administered.Due to inappropriate manipulation during surgery,the lens was injured.The site of lens injury and clinical manifestations were different in the two cases.Symptomatic treatment and continuous follow-up were carried out.The therapeutic effect following phacoemulsification of the cataract was satisfactory.CONCLUSION Well-defined surgical incision under proper anesthesia,sufficient patient information and proficient anatomical skills of the physician are mandatory to prevent this rare adverse event.Careful and meticulous phacoemulsification of the cataract is suggested.

Objective evaluation of the changes in the crystalline lens during accommodation in young and presbyopic populations using Pentacam HR system

AIM: To quantify the changes in the lens profile with accommodation in different age groups. METHODS: The Pentacam HR system was used to obtain the images of the anterior eye segment from 23 young and 15 presbyopic emmetropic subjects in unaccommodated (with an accommodation stimulus of 0.0D) and accommodated (with an accommodation stimulus of 5.0D for the young group and 1.0D for the presbyopic group) states. The phakic crystalline lens shape, including curvature of crystalline lens and central lens thickness (CLT), and the measurements of anterior segment length (ASL), central anterior chamber depth (CACD) were investigated. The anterior chamber volume (ACV) was also measured. RESULTS: The reduction of CACD and ACV were significant in both groups after accommodation stimulus. From the profile of anterior eye segment, a significant decrease in anterior crystalline lens radii of curvature (-2.52mm) and a mean increase in CLT (0.222mm) and ASL (0.1138mm) were found in the. young group with an accommodation stimulus of 5.0D. However, no statistically significant changes of CLT, ASL, or crystalline lens radii of curvature were found in the presbyopic group. CONCLUSION: Our data showed that the shallowing of anterior chamber during accommodation was caused by the forward bulging of the anterior lens surface, rather than by anterior shifting of lens position in either young or presbyopic subjects.

Auto-cortex of crystalline lens-induced iris neovascularization

AIM:To investigate auto-cortex of crystalline lens induced iris neovascularization (INV). METHODS: Thirty-six eyes of 36 guinea-pigs were included and divided into three groups randomly in this cohort study. Group A: the right lens nucleus was extracted and the remaining cortical lens material was aspirated thoroughly.. Group B: the lens was removed and 30 mu L precipitated lens cortex was injected into the anterior chamber again. Group C: aspirated the lens cortex of the left eyes and inject them into the right anterior chambers about 10 mu L. Clinical changes were followed by slit-lamp examination and photograph. The eye balls were enucleated at the day of 2, 4, 7, 11, 13, 17 after operation. HE was used to detect the pathological changes. ' RESULTS:Group A:INV had not been observed until the end of empirical study. The stromal layer contained thick wall vessels, without expansion. Group B: All eyes developed INV. Postoperative (po) 7 days; the eyes developed intense and extensive INV. The vessels of iris expanded remarkably and neovascularization was observed erupting from it's lateral wall and stretching towards the anterior surface. Poll days, INV regressed gradually after lens cortex had been absorbed. Group C: Po four (4) days, new blood vessels liking red line were presented on the anterior surface of the iris and they were not obvious. CONCLUSION: Anterior chamber inside lens coriaceous can induce iris new blood vessels.

Intraocular lens selection in diabetic patients:How to increase the odds for success

The incidence of cataracts is significantly higher in diabetic individuals,particularly in younger age groups,with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics.Cataract surgery in diabetic patients poses many challenges:Poor epithelial healing,decreased corneal sensitivity,increased central corneal thickness,decreased endothelial cell count,variable topography,poor pupillary dilatation,anterior capsular phimosis,posterior capsular opacification(PCO),chances of progression of diabetic retinopathy(DR),zonular weakness,and vitreous prolapse and diabetic macular edema.Selection of an appropriate intraocular lens(IOL)is crucial for visual rehabilitation and monitoring DR.The choice of IOL in diabetic cataract patients is a challenging scenario.Square-edge IOLs are favored for their capacity to mitigate PCO,whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR.The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation,particularly in the presence of advanced retinopathy.Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications.Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes.This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.

Clinical prediction of insufficient vaults after implantable collamer lens implantation

AIM:To determine the factors related to preoperative ocular characters that are predictive of insufficient vault(<250μm)after implantable collamer lens(ICL V4c;STAAR Surgical)implantation.METHODS:The participants underwent ICL surgery and were divided into the low(<250μm)and normal(250-1000μm)vault groups based on the postoperative vault at 3mo.The preoperative biometric parameters and clinical outcomes were compared between the two groups.The relationship between the 3-month vault values and preoperative ocular parameters were evaluated by Generalized estimating equations.RESULTS:Sixteen(23 eyes)and 36 patients(63 eyes)were in the low and normal vault groups,respectively.All implantation procedures were uneventful with no cataract formation in the early postoperative period.The sulcusto-sulcus lens rise(STSL)and iris ciliary angle(ICA)were correlated with vault at 3mo after surgery.Every 0.1 mm increase in STSL was associated with 38.9μm decrease in the postoperative 3-month vault.A rise of 1 degree in ICA is associated with a reduction of 4μm in vault.CONCLUSION:Eyes with a narrow ciliary sulcus are associated with a higher rate of low vault after ICL implantation,suggesting a need for adjustments to the ICL size in these patients.Evaluating the characteristics of the ciliary sulcus contributes valuable information to predict low vault after surgery.

Impact of multifocal gas-permeable lens designs on short-term choroidal response, axial length, and retinal defocus profile

AIM:To investigate the impact of multifocal gas permeable contact lens(MFGPCL)in various add power and distance/near area allocation on short-term changes of choroidal thickness(ChT),axial length(AL),and retinal defocus profile in young adults.METHODS:Seventeen young adults(2 males and 15 females;age 23.17±4.48y)were randomly assigned to wear two designs binocularly with a one-week washout period in between.Total of four MFGPCL designs were assessed.All designs were distance-center that varied in two add power(+1.50 and 3.00 D)and/or two distance zone(DZ)diameters(1.50 and 3.00 mm;design A:DZ 1.5/add 3.0,B:DZ 1.5/add 1.5,C:DZ 3.0/add 3.0,D:DZ 3.0/add 1.5).ChT,AL,and peripheral refraction data were collected on each subject at baseline,on days 1 and 7 of MFGPCL daily wear.ChT was assessed in four quadrants using a spectraldomain optical coherence tomography.RESULTS:AL was shortened by-26±44μm with lens C,-18±27μm with lens D,-13±29μm with lens A,and-8±30μm with lens B(all P<0.05).A significant overall increase in ChT was observed with all 4 designs(lens A:+6±6μm,B:+3±7μm,C:+8±7μm,and D:+8±7μm).Temporal and superior choroid exhibited more choroidal thickening associated with MFGPCL.All designs induced significant relative peripheral myopia(RPM)beyond the central 20o across the horizontal meridian in both nasal and temporal fields(P<0.05).CONCLUSION:MFGPCLs show a significant influence on ChT and AL,which are associated with significant increase in RPM after short-term wear.The reliability and feasibility of quantifying short-term changes in ChT support its use as a promising marker for the long-term efficacy of myopia-controlling treatments.

Rhegmatogenous retinal detachment in highly myopic eyes with implantable collamer lens

AIM:To investigate the clinical characteristics,treatment methods and outcomes of rhegmatogenous retinal detachment(RRD)in highly myopic eyes with implantable collamer lens(ICL).METHODS:High myopia patients who received treatment for nontraumatic RRD after ICL implantation surgery at the Retinal Department of Zhongshan Ophthalmic Center from Jan 2018 to Dec 2022 were reviewed.Comprehensive ophthalmologic examinations including visual acuity measurement and digital fundus photography were performed in each patient.RESULTS:A total of nine RRD eyes from nine patients who received V4c-ICL implantation were included.The mean time from ICL implantation surgery to the diagnosis of RRD was 32.44±22.56mo(range,1-60mo).At the initial visit for RRD,giant retinal tear(GRT),horseshoe tear,simple round hole,and horseshoe tear combined with round hole were detected in 3,3,2,and 1 eye(s),respectively,with maculaoff in eyes.Eight patients received surgical treatment,and one patient was treated by retinal laser photocoagulation alone.The ICL was preserved in 7 eyes.At the last followup,the mean best corrected visual acuity(BCVA)improved significantly from 1.76±1.06 logMAR at presentation to 0.81±1.01 logMAR(P=0.035),and no case of recurrent retinal detachment was found.CONCLUSION:The morphological presentation of retinal breaks is diverse in this study.The ICL can be preserved in most cases during the course of retinal detachment repair surgery in our data,companied with acceptable visual and anatomical outcomes.

Effectiveness and safety of early lens extraction during par plana vitrectomy for proliferative diabetes retinopathy with mild cataract:a randomized clinical trial

●AIM:To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR)compared to those of PPV with subsequent cataract surgery.●METHODS:This multicenter randomized controlled trial was conducted in three Chinese hospitals on patients with PDR,aged>45y,with mild cataracts.The participants were randomly assigned to the combined(PPV combined with simultaneously cataract surgery,i.e.,phacovitrectomy)or subsequent(PPV with subsequent cataract surgery 6mo later)group and followed up for 12mo.The primary outcome was the change in best-corrected visual acuity(BCVA)from baseline to 6mo,and the secondary outcomes included complication rates and medical expenses.●RESULTS:In total,129 patients with PDR were recruited and equally randomized(66 and 63 in the combined and subsequent groups respectively).The change in BCVA in the combined group[mean,36.90 letters;95%confidence interval(CI),30.35–43.45]was significantly better(adjusted difference,16.43;95%CI,8.77–24.08;P<0.001)than in the subsequent group(mean,22.40 letters;95%CI,15.55–29.24)6mo after the PPV,with no significant difference between the two groups at 12mo.The overall surgical risk of two sequential surgeries was significantly higher than that of the combined surgery for neovascular glaucoma(17.65%vs 3.77%,P=0.005).No significant differences were found in the photocoagulation spots,surgical time,and economic expenses between two groups.In the subsequent group,the duration of work incapacity(22.54±9.11d)was significantly longer(P<0.001)than that of the combined group(12.44±6.48d).●CONCLUSION:PDR patients aged over 45y with mild cataract can also benefit from early lens extraction during PPV with gratifying effectiveness,safety and convenience,compared to sequential surgeries.

Design and fabrication of compound varifocal lens driven by polydimethylsiloxane film elastic deformation

A compound varifocal lens based on electromagnetic drive technology is designed and fabricated, where the polydimethylsiloxane(PDMS) film acts as a driving component, while the PDMS biconvex lens and the plane-concave lens form a coaxial compound lens system. The plane-concave lens equipped with driving coils is installed directly above the PDMS lens surrounded by the annular magnet. When different currents are applied, the annular magnet moves up and down, driving the PDMS film to undergo elastic deformation, and then resulting in longitudinal movement of the PDMS lens. The position change of the PDMS lens changes the focal length of the compound lens system. To verify the feasibility and practicability of this design, a prototype of our compound lens system is fabricated in experiment. Our proposed compound lens shows that its zoom ability reaches 9.28 mm when the current ranges from -0.20 A to 0.21 A.

Refractive outcomes after V4c Toric collamer lens implantation over 1y of follow-up

AIM:To evaluate refractive outcomes and corneal astigmatism changes after Toric implantable collamer lens with a central port(V4c T-ICL)implantation over 1y of follow-up.METHODS:A retrospective study was performed including 50 eyes of 50 patients that underwent V4c T-ICL implantation.Uncorrected(UDVA)and corrected(CDVA)distance visual acuities,refraction,refractive and corneal astigmatism changes and corneal coupling correction were evaluated preoperatively,1 and 12mo postoperatively.Vector analysis was used for astigmatism changes.Coefficient of adjustment(CAdj)was calculated for corneal coupling analysis.RESULTS:The mean UDVA achieved was 0.03 logMAR at 1mo and remained unchanged throughout the whole follow-up(P=0.193).At the last visit,84%of the eyes achieved a CDVA of 0.00 logMAR or better.Regarding spherical equivalent refraction(SEQ),96%of eyes were ranges of±1.00 D and 84%of them within±0.50 D.Also,94%of eyes had a remaining refractive cylinder within±1.00 D and 78%of them within±0.50 D.Both,SEQ and refractive cylinder,remain stable over the postoperative follow-up(P=1.000 and P=0.660,respectively).In terms of surgically induced astigmatism(SIA),no statistically significant differences were found over the follow-up(P=0.102)and under correction was found with a correction index lower than the unit at each visit.A keratometric astigmatism induced of 0.59±0.53(vector mean:0.26×73º)D was reached at the last visit.No significant changes in terms of corneal astigmatism orientation were reported over post-surgery visits(P=0.129 and P=0.097 at 1 and 12mo respectively).No clinical significance was found for CAdj on with-the-rule astigmatism.No postoperative complications resulting from the surgery were found.CONCLUSION:Refractive outcomes suggest that the V4c T-ICL implantation for correction of myopic astigmatism was satisfactory in terms of effectiveness,safety,and stability during 1y of follow-up.Corneal astigmatism induced by the incision around 0.5 D is achieved according to the remaining refractive cylinder found at one-year post-surgery.Corneal coupling analysis results in no unexpected spherical change.

Overexpression of TRPV1 activates autophagy in human lens epithelial cells under hyperosmotic stress through Ca^(2+)-dependent AMPK/mTOR pathway

●AIM:To explore whether autophagy functions as a cellular adaptation mechanism in lens epithelial cells(LECs)under hyperosmotic stress.●METHODS:LECs were treated with hyperosmotic stress at the concentration of 270,300,400,500,or 600 mOsm for 6,12,18,24h in vitro.Polymerase chain reaction(PCR)was employed for the mRNA expression of autophagyrelated genes,while Western blotting detected the targeted protein expression.The transfection of stub-RFP-sens-GFPLC3 autophagy-related double fluorescence lentivirus was conducted to detect the level of autophagy flux.Scanning electron microscopy was used to detect the existence of autolysosome.Short interfering RNA of autophagy-related gene(ATG)7,transient receptor potential vanilloid(TRPV)1 overexpression plasmid,related agonists and inhibitors were employed to their influence on autophagy related pathway.Flow cytometry was employed to test the apoptosis and intracellular Ca^(2+)level.Mitochondrial membrane potential was measured by JC-1 staining.The cell counting kit-8 assay was used to calculate the cellular viability.The wound healing assay was used to evaluate the wound closure rate.GraphPad 6.0 software was utilized to evaluate the data.●RESULTS:The hyperosmotic stress activated autophagy in a pressure-and time-dependent manner in LECs.Beclin 1 protein expression and conversion of LC3B II to LC3B I increased,whereas sequestosome-1(SQSTM1)protein expression decreased.Transient Ca^(2+)influx was stimulated caused by hyperosmotic stress,levels of mammalian target of rapamycin(mTOR)phosphorylation decreased,and the level of AMP-activated protein kinase(AMPK)phosphorylation increased in the early stage.Based on this evidence,autophagy activation through the Ca^(2+)-dependent AMPK/mTOR pathway might represent an adaptation process in LECs under hyperosmotic stress.Hyperosmotic stress decreased cellular viability and accelerated apoptosis in LECs and cellular migration decreased.Inhibition of autophagy by ATG7 knockdown had similar results.TRPV1 overexpression increased autophagy and might be crucial in the occurrence of autophagy promoted by hyperosmotic stress.●CONCLUSION:A combination of hyperosmotic stress and autophagy inhibition may be a promising approach to decrease the number of LECs in the capsular bag and pave the way for improving prevention of posterior capsular opacification and capsular fibrosis.

SIRT1 inhibits apoptosis of human lens epithelial cells through suppressing endoplasmic reticulum stress in vitro and in vivo

AIM:To explore the effect of silent information regulator factor 2-related enzyme 1(SIRT1)on modulating apoptosis of human lens epithelial cells(HLECs)and alleviating lens opacification of rats through suppressing endoplasmic reticulum(ER)stress.METHODS:HLECs(SRA01/04)were treated with varying concentrations of tunicamycin(TM)for 24h,and the expression of SIRT1 and C/EBP homologous protein(CHOP)was assessed using real-time quantitative polymerase chain reaction(RT-PCR),Western blotting,and immunofluorescence.Cell morphology and proliferation was evaluated using an inverted microscope and cell counting kit-8(CCK-8)assay,respectively.In the SRA01/04 cell apoptosis model,which underwent siRNA transfection for SIRT1 knockdown and SRT1720 treatment for its activation,the expression levels of SIRT1,CHOP,glucose regulated protein 78(GRP78),and activating transcription factor 4(ATF4)were examined.The potential reversal of SIRT1 knockdown effects by 4-phenyl butyric acid(4-PBA;an ER stress inhibitor)was investigated.In vivo,age-related cataract(ARC)rat models were induced by sodium selenite injection,and the protective role of SIRT1,activated by SRT1720 intraperitoneal injections,was evaluated through morphology observation,hematoxylin and eosin(H&E)staining,Western blotting,and RT-PCR.RESULTS:SIRT1 expression was downregulated in TMinduced SRA01/04 cells.Besides,in SRA01/04 cells,both cell apoptosis and CHOP expression increased with the rising doses of TM.ER stress was stimulated by TM,as evidenced by the increased GRP78 and ATF4 in the SRA01/04 cell apoptosis model.Inhibition of SIRT1 by siRNA knockdown increased ER stress activation,whereas SRT1720 treatment had opposite results.4-PBA partly reverse the adverse effect of SIRT1 knockdown on apoptosis.In vivo,SRT1720 attenuated the lens opacification and weakened the ER stress activation in ARC rat models.CONCLUSION:SIRT1 plays a protective role against TM-induced apoptosis in HLECs and slows the progression of cataract in rats by inhibiting ER stress.These findings suggest a novel strategy for cataract treatment focused on targeting ER stress,highlighting the therapeutic potential of SIRT1 modulation in ARC development.

Effect of capsule treatment on visual acuity and quality after phacoemulsification lens implantation in myopic patients with cataract

BACKGROUND Cataracts pose a significant clinical burden due to their complex pathogenesis.In recent years,an increase in cataracts coexisting with myopia has heightened the incidence of retinopathy and posterior vitreous detachment.Additionally,symptoms of ocular axis elongation,lens nucleus hardening,and vitreous liquefaction have become more prevalent.While conventional extracapsular cataract extraction is commonly employed,it often yields suboptimal visual outcomes.Subsequent advancements in cataract phacoemulsification and lens implantation surgeries have gained widespread acceptance for their ability to improve refraction and significantly improve uncorrected visual acuity.AIM To investigate the effect of capsular treatment after phacoemulsification lens implantation in myopic patients with cataract.METHODS We selected 110 patients(with 134 eyes)with myopia and cataracts treated.These patients were categorized into two groups:an observation group(57 patients with 70 eyes)and a control group(53 patients with 64 eyes).The control group underwent cataract phacoemulsification and lens implantation,while the observation group received a refined capsular treatment based on the control group’s procedure.We assessed the differences in visual acuity and quality between the two groups before and after surgery.RESULTS At six months post-operation,the observation group exhibited significantly improved far vision,intermediate vision,near vision,lower objective scattering index,higher Modulation transfer function cut-off frequency,and overall vision metrics at different contrast levels(100%,20%and 9%)compared to the control group(P<0.05).The total score of the National Eye Institute Visual Function Questionnaire in the observation group at 6 months after operation was significantly higher than that in the control group(P<0.05).No significant difference in the incidence of adverse reactions was observed between the observation group and control group(P>0.05).CONCLUSION Capsular treatment demonstrates efficacy in improving visual acuity and quality after phacoemulsification lens implantation in myopic patients with cataracts,warranting its clinical application.

Constructing long-cycling crystalline C_(3)N_(4)-based carbonaceous anodes for sodium-ion battery via N configuration control

Carbon nitrides with two-dimensional layered structures and high theoretical capacities are attractive as anode materials for sodium-ion batteries while their low crystallinity and insufficient structural stability strongly restrict their practical applications.Coupling carbon nitrides with conductive carbon may relieve these issues.However,little is known about the influence of nitrogen(N)configurations on the interactions between carbon and C_(3)N_(4),which is fundamentally critical for guiding the precise design of advanced C_(3)N_(4)-related electrodes.Herein,highly crystalline C_(3)N_(4)(poly(triazine imide),PTI)based all-carbon composites were developed by molten salt strategy.More importantly,the vital role of pyrrolic-N for enhancing charge transfer and boosting Na+storage of C_(3)N_(4)-based composites,which was confirmed by both theoretical and experimental evidence,was spot-highlighted for the first time.By elaborately controlling the salt composition,the composite with high pyrrolic-N and minimized graphitic-N content was obtained.Profiting from the formation of highly crystalline PTI and electrochemically favorable pyrrolic-N configurations,the composite delivered an unusual reverse growth and record-level cycling stability even after 5000 cycles along with high reversible capacity and outstanding full-cell capacity retention.This work broadens the energy storage applications of C_(3)N_(4) and provides new prospects for the design of advanced all-carbon electrodes.