Multispectral Imaging in Combination with Multivariate Analysis Discriminates Selenite Induced Cataractous Lenses from Healthy Lenses of Sprague-Dawley Rats

Cataracts are the leading cause of blindness worldwide. Current methods for discriminating cataractous lenses from healthy lenses of Sprague-Dawley rats during preclinical studies are based on either histopathological or clinical assessments which are weakened by subjectivity. In this work, both cataractous and healthy lens tissues of Sprague-Dawley rats were studied using multispectral imaging technique in combination with multivariate analysis. Multispectral images were captured in transmission, reflection and scattering modes. In all, five spectral bands were found to be markers for discriminating cataractous lenses from healthy lenses;470 nm and 625 nm discriminated in reflection mode whereas 435 nm, 590 nm and 700 nm discriminated in transmission mode. With Fisher’s Linear discriminant analysis, the midpoints for classifying cataractous from healthy lenses were found to be 14.718 × 10−14 and 3.2374 × 10−14 for the two spectra bands in the reflection mode and the three spectral bands in the transmission mode respectively. Images in scattering mode did not show significant discrimination. These spectral bands in reflection and transmission modes may offer potential diagnostic markers for discriminating cataractous lenses from healthy lenses thereby promising multispectral imaging applications for characterizing cataractous and healthy lenses.

Evaluation of antioxidants and argpyrimidine in normal and cataractous lenses in north Indian population

AIM： To assess the level of glutathione, thioltransferase, and argpyrimidine in nuclear and cortical cataractous lenses as well as in the clear lenses in the north Indian population.METHODS： Human cataractous lenses were collected from the patients who underwent extracapsular cataract extraction surgery; clear lenses were collected from the freshly donated eye bank eyes. Antioxidant molecules such as glutathione and thioltransferase enzyme activity were measured; simultaneously in these lenses a blue fluorophore argpyrimidine, an advanced glycation end（AGE） product level was assessed using high performance liquid chromatography（HPLC）.RESULTS： The protein concentration was found to be present at higher levels in the control lenses compared to cataract lenses. A significant decrease in the glutathione level was observed in the nuclear cataractous lenses compared to cortical cataractous（P=0.004） and clear lenses（P≤0.005）, but no significant change in the level of antioxidant enzyme thioltransferase was observed. Further, argpyrimidine a blue fluorophore（AGE） was found to be significantly higher in the nuclear cataract（P=0.013） compared to cortical cataract lenses.CONCLUSION： Antioxidants such as glutathione significantly decrease in age-related nuclear and cortical cataract and an AGE, argpyrimidine are present at significantly higher levels in nuclear cataract.

TRACE ELEMENTAL ANALYSIS OF RAT CATARACTOUS LENSES BY PIXE

Cataracts were observed in the eye lenses of a group of Wistar rats that had been injected with Na2SeO3. The trace elemental analysis of their lenses was carried out by PIXE. The results showed that the variations of elemental contents were different between the injected rats and the controls. The elemental concentrations, which exhibited a certain regularity in their variations,could be related to the time of formation of cataract and to its state.

A Comparative Analysis of Anxiety and Depression among Glaucoma and Cataractous Patients in Southwest Nigeria

Background: Glaucoma is the leading cause of irreversible blindness worldwide. An appreciable proportion of glaucoma patients have been found to have hidden psychiatric disorders that often go undetected. Anxiety and depression have been found to be major contributors to these psychological issues. This present study aims to compare the prevalence of anxiety and depression amongst glaucoma and cataract patients and to identify risk factors for anxiety and depression amongst these patients. Materials and Methods: A comparative crossectional study was carried out among 197 Primary Open Angle Glaucoma (POAG) patients and 197 controls (non-POAG patients that have no ocular disorder other than cataract) attending Deseret Community Vision Institute, Ijebu Imushin, Ogun state from 1st of April to 31st May 2014. POAG was defined as patients with open anterior chamber angles based on gonioscopy, pale and cupped discs (Cup: Disc ratio ≥ 0.4), and corresponding visual field defects with or without an elevated intraocular pressure. Cataract was defined as patients with opacification of the crystalline lens in either or both eyes. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression among the participants. Data were analyzed using SPSS Version 20 using Chi-square, Independent student T-test and Logistic regression. Results: The mean age of glaucoma subjects was 62.24 years and the cataract subjects was 64.2 years. There was a male preponderance with a male: female ratio of 1.5:1. Anxiety as defined by the HADS was seen in 35.5% of glaucoma patients and 21.8% of the cataract patients but there was no statistically significant difference after controlling for sociodermographic and clinical characteristics on logistic regression. The risk factors for anxiety among the glaucoma participants were those younger than 60 (OR 2.9, 95% CI: 1.3 - 6.5 p = 0.009) and those with severe glaucoma (OR 9.5, 95% CI: 1.7 - 54.4 p = 0.011). The risk factors for anxiety among cataract patients were sociodermographic factors. Those employed (OR 6.4. 95% CI: 2.1 - 20.0 p = 0.001) and those separated and divorced (OR 10.3, 95% CI: 1.4 - 78.4 p = 0.002). Visual status was not a risk factor amongst the cataract participants. Depression as defined by HADS was seen in 24.4% of glaucoma participants and 3.6% of cataract participants. Glaucoma participants were four times more likely to be depressed than the cataract participants after controlling for clinical and sociodermographic variables (OR 4.0, 95% CI: 1.5 - 10.8 p = 0.007). The risk factors for depression among the glaucoma participants were those younger than 60 (OR 4.7, 95% CI: 1.7 - 13.5 p = 0.004), those with primary (OR 6.6, 95% CI: 1.5 - 28.4) p = 0.010) and secondary education (OR 8.0, 95% CI: 2.1 - 29.9 p = 0.002) as compared to those with tertiary education, those unemployed (OR 2.0, 95% CI: 1.0 - 7.2 p = 0.042) as compared to those employed. Those blind (OR 10.8. 95% CI: 2.8 - 42.4 p = 0.001) as compared to those without visual impairment and those that had had surgery (OR 3.7, 95% CI: 1.4 - 10.0 p = 0.011). Conclusion: Anxiety and Depression were found in 35.5% and 24.4% of glaucoma patients as compared to 21.8% and 3.6% of cataract patients respectively. Glaucoma patients were 4 times more likely to be depressed than patients with cataracts. There was no significant difference in anxiety between the two groups but glaucoma patients had a four times higher risk of being depressed as compared to cataract patients. There is a need to address these psychological issues at the community level in order to improve the quality of life of these patients. It is also important to identify those at risk in order to curb this growing trend/concern.

Characterization of N6-methyladenosine long non-coding RNAs in sporadic congenital cataract and age-related cataract

AIM:To characterize the N6-methyladenosine(m6A)modification patterns in long non-coding RNAs(lncRNAs)in sporadic congenital cataract(CC)and age-related cataract(ARC).METHODS:Anterior capsule of the lens were collected from patients with CC and ARC.Methylated RNA immunoprecipitation with next-generation sequencing and RNA sequencing were performed to identify m6A-tagged lncRNAs and lncRNAs expression.Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses and Gene Ontology annotation were used to predict potential functions of the m6A-lncRNAs.RESULTS:Large amount of m6A peaks within lncRNA were identified for both CC and ARC,while the level was much higher in ARC(49870 peaks)than that in CC(18688 peaks),yet those difference between ARC in younger age group(ARC-1)and ARC in elder age group(ARC-2)was quite slight.A total of 1305 hypermethylated and 1178 hypomethylated lncRNAs,as well as 182 differential expressed lncRNAs were exhibited in ARC compared with CC.On the other hand,5893 hypermethylated and 5213 hypomethylated lncRNAs,as well as 155 significantly altered lncRNA were identified in ARC-2 compared with ARC-1.Altered lncRNAs in ARC were mainly associated with the organization and biogenesis of intracellular organelles,as well as nucleotide excision repair.CONCLUSION:Our results for the first time present an overview of the m6A methylomes of lncRNA in CC and ARC,providing a solid basis and uncovering a new insight to reveal the potential pathogenic mechanism of CC and ARC.

Research progress on the correlation between aqueous humor components and pathogenesis and postoperative complications in patients with different types of cataracts

Aqueous humor provides the necessary nutrition for the lens and transports the metabolites in the eye.It was a liquid that can directly reflect the microenvironment in the eye'and it can be easily obtained during the operation.This review intended to analyze the components of aqueous humor in patients with different types of cataracts'so as to reflect the pathogenesis and development of the disease'evaluate the incidence of postoperative complications and provide reference value for the surgical design of sequential cataract surgery.The aqueous humor components of different types of cataracts showed different degrees of inflammation'oxidative stress and extracellular matrix remodeling.The biomarker of early neuropathy in diabetic cataract was neural cell adhesion molecule-1(NCAM1).Transforming growth factor-β(TGF-β)was the evaluation factor of disease development in patients with pseudoexfoliation syndrome.The relationships between postoperative complications of different types of cataracts and aqueous humor components were as follows:Macular edema after diabetic cataract surgery was associated with tumor necrosis factor-alpha;capsular contraction after high myopic cataract surgery was related to monocyte chemoattractant protein-1(MCP-1)and TGF-β2;Klotho and glutathione S-transferase P 1(GSTP1)were associated with high intraocular pressure after primary open-angle glaucoma complicated by cataract surgery;capsular contraction after retinitis pigmentosa complicated by cataract surgery was associated with matrix metalloproteinases;pro-inflammatory cytokines and fibroblast growth factor 4 in the aqueous humor of congenital cataracts were associated with posterior capsular opacification after surgery.Granulocyte colony stimulating factor 3 and MCP-1 were the main cytokines mediating the pain of the second eye in the binocular sequential cataract surgery short interval(1 wk)'while MCP-1 mediated pain in the long interval(6 wk).The second eye after binocular sequential cataract surgery had a higher level of proinflammatory factors.The components of aqueous humor in patients with different types of cataracts were related to the pathogenesis and postoperative complications of the disease.Monitoring the components of the aqueous humor could help better understand the intraocular microenvironment of different types of cataracts and provide a reference for predicting the development of the disease and implementing relevant targeted therapy.

Insight into small eyes: a practical description from phenotypes presentations to the management

This narrative review aimed to have an algorithmic approach to microphthalmos by a systematic search.The definition can be related to a number of special phenotypes.In the more challenging cases of complex microphthalmos,relative anterior microphthalmos,and nanophthalmos,the surgeon can approach these cases more safely if they have a deep understanding of the anatomical variations and ideal formulae for intraocular lens computation and knows how to avoid intra-and post-operative complications.In this article,we review the criteria by which we recognize and describe pre-,intra-,and post-operative considerations,as well as discuss the ideal intraocular lenses for microphthalmos,given the intricate varieties of small eye phenotypes.

EVA NEXUS-Phaco performance study

AIM:To investigate a novel phacoemulsification system“EVA NEXUS”(D.O.R.C.,Dutch Opthalmic Research Center)in comparison to the existing system“EVA”in clinical use.And to compare both phacoemulsification systems in terms of efficiency,safety and postoperative inflammatory activity.METHODS:In this study standardized cataract surgery was performed on both eyes of the study participant,using the“EVA system”(control group,n=20)on one eye and the“EVA NEXUS system”(intervention group,n=20)on the other eye.Only patients with cataract LOCS Grading 1-3 and no accompanying eye diseases were included in this study.A total of 20 patients were included in this study,with each treatment arm including 20 eyes.During surgery a 0.1 mL aqueous humor sample was collected 1min after phacoemulsification to measure the total prostaglanin E2 concentrations using an enzyme-linked immunosorbent assay.The endothelial cell count,visual and refractive outcomes,and anterior chamber flare were evaluated preoperatively,and 1d,1wk,and 3mo postoperatively.RESULTS:There were no statistically significant differences between both groups regarding intraoperative safety parameters including effective phacoemulsification time(P=0.904),balanced saline solution flow(P=0.701)and total surgery time(P=0.565).Postoperative prostaglandin E2 levels,anterior chamber flare as well as endothelial cell loss tended to be lower in the NEXUS-Group,however not being statistically significant(P=0.718;0.164;0.486).Both systems provided similar clinical outcomes,regarding best corrected visual acuity and refractive parameters,showing no statistically significant differences between both groups.CONCLUSION:Both systems show a high level of safety and efficency with similar results in terms of safety parameters including postoperative inflammatory activity and endothelial cell loss as well as visual and refractive outcomes.Although statistically not significant,the EVA NEXUS system tends to cause less postoperative inflammation with lower prostaglandin E2 levels and lower anterior chamber flare values.

Are there sex-based disparities in cataract surgery?

AIM:To investigate sex-based differences in the occurrence of intra-operative and post-operative complications and associated visual outcomes following cataract surgery.METHODS:This was a retrospective study of patients who had phacoemulsification cataract surgery at the University of Colorado School of Medicine.Data collected included the patient’s health history,ocular comorbidities,operative and post-operative complications,and the post-operative best corrected visual acuity(BCVA).The data were analyzed using univariate and multivariable logistic regression with generalized estimating equations to account for the correlation of some patients having two eyes included in the study.RESULTS:A total of 11977 eyes from 7253 patients were included in the study.Ocular comorbidities differed by sex,with males having significantly higher percentages of traumatic cataracts(males 0.7%vs females 0.1%),prior ocular surgery(6.7%vs 5.5%),and mature cataracts(2.8%vs 1.9%).Conversely,females had significantly higher rates of pseudoexfoliation(2.0%vs 3.2%).In unadjusted analysis,males had higher rates of posterior capsular rupture(0.8%vs 0.4%)and vitreous loss(1.0%vs 0.6%),but this difference was not significant after adjustment for confounders.Males had a significantly increased risk of post-operative retinal detachment,but in multivariable analysis this was no longer significant.Males were significantly less likely to undergo post-operative neodymium-doped yttrium aluminum garnet(Nd:YAG)laser capsulotomy for posterior capsule opacification(OR=0.8,95%CI=0.7-0.9,P=0.0005).The BCVA was slightly worse for males pre-operatively;but post-operatively,both sexes exhibited similar visual acuity of Snellen equivalent 20/25.CONCLUSION:The study finds that in a cohort of patients presenting for cataract surgery,sex differences exist in pre-operative comorbidities and surgical characteristics that contribute to higher rates of some complications for males.However,observed surgical complication rates exhibit almost no difference by sex after adjusting for pre-operative differences and post-operative BCVA is similar between sexes.

Systematic bibliometric analysis of research hotspots and trends on the application of premium IOLs in the past 2 decades

AIM:To analysis of research hotspots and trends on the application of premium intraocular lens(PIOLs)in the past 2 decades.METHODS:The literature search was performed on the Web of Science and included PIOLs studies published between January 2000 and December 2022.The retrieved literature was collated and analyzed by R-tool’s Bibliometrix package,CitNetExplorer,CiteSpace and other software.RESULTS:A total of 1801 articles about PIOLs were obtained,most of which were published in Spain and the United States.The organization that published the most articles was the University of Valencia in Spain.Alió JL,and Montés-Micó R,from Spain were the most influential authors in this field.The Journal of Cataract and Refractive Surgery and Journal of Refractive Surgery were the core journals for this field;the top 10 cited articles mainly focus on postoperative satisfaction with multifocal intraocular lens(IOLs)and postoperative results of toric IOLs.Through the keyword analysis,we found that trifocal IOLs,astigmatism and extended depth of focus(EDoF)IOLs are the most discussed topics at present,and the importance of astigmatism and the clinical application of the new generation of PIOLs are the emerging research trends.CONCLUSION:Bibliometric analysis can effectively help to identify multilevel concerns in PIOLs research and the prevailing research trends in the realm of PIOLs encompass the adoption of EDoF IOLs,trifocal IOLs,and their respective Toric models.

Combinative approach of transzonular triamcinolonemoxifloxacin and perioperative drops to minimize postoperative complications of cataract surgery

AIM: To investigate the effectiveness of combinationtherapy with transzonular triamcinolone-moxifloxacin andconventional perioperative drops in reducing postoperativecomplications of cataract surgery. METHODS: Electronic medical records of cataractsurgery patients (single surgeon) were reviewed fromJanuary 2018 to September 2021. The rate of postoperativecomplications including prolonged and/or recurrentpostoperative inflammation, endophthalmitis, cystoid macularedema (CME), and intraocular pressure (IOP) was comparedbetween the patients receiving combinative therapy andpatients receiving drops only. RESULTS: Totally 596 patients and 1057 eyes(Combinative-Therapy group 493 and Drop-Only group 564)were included in this study. Using combination therapyreduced the relative risk of postoperative inflammationby 26.9% (16.6% Combinative-Therapy vs 22.7% Drop-Only, P=0.013). The incidence of endophthalmitis was 0in Combinative-Therapy group vs 0.5% in Drop-Only group(relative risk reduction 100%), although not statisticallysignificant (P=0.10). The incidence of severe IOP spikeswas not significantly different between Combinative-Therapy (2.4%) and Drop-Only (1.6%) groups (P=0.33).The relative risk of postoperative CME was 51.4% less inthree months follow up visit in Combinative-Therapy group,although not statistically significant (P=0.07). The visualoutcome 1-month postop. (best corrected visual acuity) wassignificantly better in Combinative-Therapy (logMAR 0.10)compared to Drop-Only (logMAR 0.14) groups (P=0.02) whilethe baseline visual acuity was not significantly different. CONCLUSION: The combinative approach oftranszonular triamcinolone-moxifloxacin plus perioperativeeyedrops is an effective method to minimize postoperativeinflammation, with better visual outcomes. It couldpotentially reduce the risk of postoperative endophthalmitisand CME (near-significant P-values;larger studies couldanalyze better considering low incidence).

Classification of congenital cataracts based on multidimensional phenotypes and its association with visual outcomes

●AIM:To establish a classification for congenital cataracts that can facilitate individualized treatment and help identify individuals with a high likelihood of different visual outcomes.●METHODS:Consecutive patients diagnosed with congenital cataracts and undergoing surgery between January 2005 and November 2021 were recruited.Data on visual outcomes and the phenotypic characteristics of ocular biometry and the anterior and posterior segments were extracted from the patients’medical records.A hierarchical cluster analysis was performed.The main outcome measure was the identification of distinct clusters of eyes with congenital cataracts.●RESULTS:A total of 164 children(299 eyes)were divided into two clusters based on their ocular features.Cluster 1(96 eyes)had a shorter axial length(mean±SD,19.44±1.68 mm),a low prevalence of macular abnormalities(1.04%),and no retinal abnormalities or posterior cataracts.Cluster 2(203 eyes)had a greater axial length(mean±SD,20.42±2.10 mm)and a higher prevalence of macular abnormalities(8.37%),retinal abnormalities(98.52%),and posterior cataracts(4.93%).Compared with the eyes in Cluster 2(57.14%),those in Cluster 1(71.88%)had a 2.2 times higher chance of good best-corrected visual acuity[<0.7 logMAR;OR(95%CI),2.20(1.25–3.81);P=0.006].●CONCLUSION:This retrospective study categorizes congenital cataracts into two distinct clusters,each associated with a different likelihood of visual outcomes.This innovative classification may enable the personalization and prioritization of early interventions for patients who may gain the greatest benefit,thereby making strides toward precision medicine in the field of congenital cataracts.

Pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries under topical anesthesia

Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery.Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery.However,patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery.The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts.Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system.Immunological,neuropsychological,and pharmacological factors work together in the enhancement of intraoperative pain.Accumulating published literatures have focused on the pain enhancement during the secondeye phacoemulsification surgeries.In this review,we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb.1,2024.We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries.This review aimed to provide novel insights into strategies for improving patients’intraoperative experience in second-eye cataract surgeries.

Resolution of myopic macular schisis following cataract phacoemulsification

Dear Editor,We write to introduce a case of high myopia who had bilateral macular schisis along with cataracts.During the following-up period from 2014 to 2021,the severity of macular schisis gradually worsened.However,following cataract surgery,there was a gradual improvement in the macular schisis,ultimately leading to near-complete resolution.We obtained the written informed consent from the patient,and this case study adhered to the principles in the Declaration of Helsinki.

Abnormal function of EPHA2/p.R957P mutant in congenital cataract

AIM:To identify genetic defects in a Chinese family with congenital posterior polar cataracts and assess the pathogenicity.METHODS:A four-generation Chinese family affected with autosomal dominant congenital cataract was recruited.Nineteen individuals took part in this study including 5 affected and 14 unaffected individuals.Sanger sequencing targeted hot-spot regions of 27 congenital cataract-causing genes for variant discovery.The pathogenicity of the variant was evaluated by the guidelines of American College of Medical Genetics and InterVar software.Confocal microscopy was applied to detect the subcellular localization of fluorescence-labeled ephrin type-A receptor 2(EPHA2).Co-immunoprecipitation assay was implemented to estimate the interaction between EphA2 and other lens membrane proteins.The mRNA and protein expression were analyzed by reverse transcription-polymerase chain reaction(qRT-PCR)and Western blotting assay,respectively.The cell migration was analyzed by wound healing assay.Zebrafish model was generated by ectopic expression of human EPHA2/p.R957P mutant to demonstrate whether the mutant could cause lens opacity in vivo.RESULTS:A novel missense and pathogenic variant c.2870G>C was identified in the sterile alpha motif(SAM)domain of EPHA2.Functional studies demonstrated the variant’s impact:reduced EPHA2 protein expression,altered subcellular localization,and disrupted interactions with other lens membrane proteins.This mutant notably enhanced human lens epithelial cell migration,and induced a central cloudy region and roughness in zebrafish lenses with ectopic expression of human EPHA2/p.R957P mutant under differential interference contrast(DIC)optics.CONCLUSION:Novel pathogenic c.2870G>C variant of EPHA2 in a Chinese congenital cataract family contributes to disease pathogenesis.

Novel MIP gene mutation causes autosomal-dominant congenital cataract

●AIM:To identify disease-causative mutations in families with congenital cataract.●METHODS:Two Chinese families with autosomaldominant congenital cataract(ADCC)were recruited and underwent comprehensive eye examinations.Gene panel next-generation sequencing of common pathogenic genes of congenital cataract was performed in the proband of each family.Sanger sequencing was used to valid the candidate gene mutations and sequence the other family members for co-segregation analysis.The effect of sequence changes on protein structure and function was predicted through bioinformatics analysis.Major intrinsic protein(MIP)-wildtype and MIP-G29R plasmids were constructed and microinjected into zebrafish single-cell stage embryos.Zebrafish embryonic lens phenotypes were screened using confocal microscopy.●RESULTS:A novel heterozygous mutation(c.85G>A;p.G29R)in the MIP gene was identified in the proband of one family.A known heterozygous mutation(c.97C>T;p.R33C;rs864309693)in MIP was found in the proband of another family.In-silico prediction indicated that the novel mutation might affect the MIP protein function.Zebrafish embryonic lens was uniformly transparent in both wild-type PCS2+MIP and mutant PCS2+MIP.●CONCLUSION:Two missense mutations in the MIP gene in Chinese cataract families are identified,and one of which is novel.These findings expand the genetic spectrum of MIP mutations associated with cataracts.The functional studies suggest that the novel MIP mutation might not be a gain-of-function but a loss-of-function mutation.

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.

Global trends in diabetic eye disease research from 2012 to 2021

Diabetic eye disease refers to a group of eye complications that occur in diabetic patients and include diabetic retinopathy, diabetic macular edema, diabetic cataracts, and diabetic glaucoma. However, the global epidemiology of these conditions has not been well characterized. In this study, we collected information on diabetic eye disease-related research grants from seven representative countries––the United States, China, Japan, the United Kingdom, Spain, Germany, and France––by searching for all global diabetic eye disease journal articles in the Web of Science and Pub Med databases, all global registered clinical trials in the Clinical Trials database, and new drugs approved by the United States, China, Japan, and EU agencies from 2012 to 2021. During this time period, diabetic retinopathy accounted for the vast majority(89.53%) of the 2288 government research grants that were funded to investigate diabetic eye disease, followed by diabetic macular edema(9.27%). The United States granted the most research funding for diabetic eye disease out of the seven countries assessed. The research objectives of grants focusing on diabetic retinopathy and diabetic macular edema differed by country. Additionally, the United States was dominant in terms of research output, publishing 17.53% of global papers about diabetic eye disease and receiving 22.58% of total citations. The United States and the United Kingdom led international collaborations in research into diabetic eye disease. Of the 415 clinical trials that we identified, diabetic macular edema was the major disease that was targeted for drug development(58.19%). Approximately half of the trials(49.13%) pertained to angiogenesis. However, few drugs were approved for ophthalmic(40 out of 1830;2.19%) and diabetic eye disease(3 out of 1830;0.02%) applications. Our findings show that basic and translational research related to diabetic eye disease in the past decade has not been highly active, and has yielded few new treatment methods and newly approved drugs.

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review

Among refractive errors,astigmatism is the most common optical aberration,where refraction changes in different meridians of the eye.It causes blurred vision at any distance and includes corneal,lenticular,and retinal astigmatism.Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism,for example,a large size surgery incision.The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery.Nowadays,three surgical approaches can be used.By placing a sutureless clear corneal incision on the steep meridian of the cornea,a preoperative corneal astigmatism less than 1.0 D can be corrected.Single or paired peripheral corneal relaxing incisions(PCRIs)provide 1.0-3.0 D corneal astigmatism correction.PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism,if more than 2.0 D,the risk of overcorrection and irregular astigmatism is increased.When toric intraocular lenses(IOLs)are unavailable in markets,PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism.Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism.Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D.These approaches can be used alone or in combination.

Intraocular pressure before and after capsulorhexis using two viscoelastic substances and two surgical approaches in enucleated porcine eyes

AIM:To investigate the influence of ophthalmic viscoelastic devices(OVDs)and different surgical approaches on the intraocular pressure(IOP)before and after creation of the curvilinear circular capsulorhexis(CCC)as a measure for anterior chamber stability during this maneuver.METHODS:Prospective experimental WetLab study carried out on enucleated porcine eyes.IOP was measured before and after CCC with the iCare Rebound tonometer(iCare ic200;iCare Finland Oy,Vantaa,Finland).The OVDs used were a cohesive one[Z-Hyalin,Carl Zeiss Meditec AG,Germany;hyaluronic acid(HA)]and a dispersive[Z-Celcoat,Carl Zeiss Meditec AG,Germany;hydroxy propylmethylcellulosis(HPMC)].The CCC was created using Utrata forceps or 23 g microforceps in different combinations with the OVDs.RESULTS:Using the Utrata forceps the IOP dropped from 63.65±6.44 to 11.25±3.63 mm Hg during the CCC.The use of different OVDs made no difference.Using the 23 g microforceps the IOP dropped from 65.35±8.15 to 36.55±6.09 mm Hg.The difference between IOP drop using either Utrata forceps or 23 g microforceps was highly significant regardless of the OVD used.CONCLUSION:Using the sideport for the creation of the capsulorhexis leads to a lesser drop in IOP during this maneuver compared to the main incision in enucleated porcine eyes.The use of different OVD has no significant influence on IOP drop.