An interpretable model predicts visual outcomes of no light perception eyes after open globe injury.

BACKGROUND: The visual outcome of open globe injury (OGI)-no light perception (NLP) eyes is unpredictable traditionally. This study aimed to develop a model to predict the visual outcomes of vitrectomy surgery in OGI-NLP eyes using a machine learning algorithm and to provide an interpretable system for the prediction results. METHODS: Clinical data of 459 OGI-NLP eyes were retrospectively collected from 19 medical centres across China to establish a training data set for developing a model, called 'VisionGo', which can predict the visual outcome of the patients involved and compare with the Ocular Trauma Score (OTS). Another 72 cases were retrospectively collected and used for human-machine comparison, and an additional 27 cases were prospectively collected for real-world validation of the model. The SHapley Additive exPlanations method was applied to analyse feature contribution to the model. An online platform was built for real-world application. RESULTS: The area under the receiver operating characteristic curve (AUC) of VisionGo was 0.75 and 0.90 in previtrectomy and intravitrectomy application scenarios, which was much higher than the OTS (AUC=0.49). VisionGo showed better performance than ophthalmologists in both previtrectomy and intravitrectomy application scenarios (AUC=0.73 vs 0.57 and 0.87 vs 0.64). In real-world validation, VisionGo achieved an AUC of 0.60 and 0.91 in previtrectomy and intravitrectomy application scenarios. Feature contribution analysis indicated that wound length-related indicators, vitreous status and retina-related indicators contributed highly to visual outcomes. CONCLUSIONS: VisionGo has achieved an accurate and reliable prediction in visual outcome after vitrectomy for OGI-NLP eyes.

Endogenous listeria monocytogenes endophthalmitis in a cirrhotic patient.

Endogenous endophthalmitis caused by listeria monocytogenes is rare and serious, which is easily misdiagnosed initially. We present one case of endogenous endophthalmitis due to listeria monocytogenes in a cirrhotic patient, whose diagnosis was delayed 17 days after admission.

Efficacy and prognosis of neuroendoscopy-assisted surgery for chronic subdural hematoma.

Objective: This paper aims to analyze the clinical effect and prognosis of neuroendoscopy-assisted surgery for chronic subdural hematoma (CSDH). Methods: The clinical data of CSDH patients who underwent surgery between March 2018 and June 2020 in the Department of Neurosurgery of the First Affiliated Hospital of Xiamen University were retrospectively collected and analyzed. Eighty patients with CSDH who met the inclusive criteria were selected. A control group (32 cases treated with burr hole drainage) and an observation group (48 cases treated with neuroendoscopy-assisted surgery) were set according to different operation methods. The hematoma clearance rate, surgery-related indicators, related complications, hematoma recurrence rate and related prognostic indicators of the two groups were compared and analyzed. Result: The postoperative hematoma clearance rate of the observation group was 92.59%, which was higher than that of the control group (77.78%) (P<0.05). The operation time of the observation group was longer than that of the control group (P<0.05). The postoperative hospitalization time of the observation group was shorter than that of the control group (P<0.05). The postoperative complication rate of the observation group was lower than that of the control group (P<0.05). The recurrence rate of hematoma in the observation group in the six-month postoperative follow-up was 1.85%, which was lower than that in the control group (P<0.05). The limb motor function and daily living ability score of the observation group were higher than those of the control group, and the Markwalder grading score was lower than that of the control group (P<0.05). Conclusion: Neuroendoscopy-assisted treatment which is safe and effective is superior to traditional burr-hole drainage surgery. It can reduce the recurrence rate; thus, it is worth advocating and applying.

Downregulation of Circular RNA PSEN1 ameliorates ferroptosis of the high glucose treated retinal pigment epithelial cells via miR-200b-3p/cofilin-2 axis.

Ferroptosis is a form of programmed cell death that participates in the progression of numerous diseases. Long noncoding RNAs (lncRNAs) are dysregulated in diabetic retinopathy (DR). However, the role of lncRNAs in DR-induced ferroptosis is unclear. Adult retinal pigment epithelial cell line-19 (ARPE19) cells were treated with a high concentration of glucose (high glucose, HG) to mimic DR in vitro. The intracellular contents of glutathione, malondialdehyde, and ferrous ions were analyzed using the corresponding kits. The MTT assay was performed to measure the cell survival rate, and cell death was determined using propidium iodide and terminal deoxynucleotidyl transferase dUTP nick end labeling staining assays. Western blotting was conducted to detect the protein levels of GPX4, SLC7A11, and TFR1. The targeting relationships were verified using luciferase reporter and RNA pull-down assays. circ-PSEN1 was upregulated in HG-treated ARPE19 cells and showed high resistance to RNase R and Act D. Inhibition of circ-PSEN1 in ARPE19 cells ameliorated the ferroptosis induced by HG was ameliorated, as evidenced by changes in the ferroptosis-related biomarkers/genes and decreased cell death. Subsequently, circ-PSEN1 acted as a sponge for miR-200b-3p. Inhibition of miR-200b-3p partially reversed the effects of circ-PSEN1 on ferroptosis. Furthermore, cofilin-2 (CFL2) was the target gene of miR-200b-3p, and it abrogated the inhibitory effect of miR-200b-3p on ferroptosis. Taken together, the findings indicate that knockdown of circ-PSEN1 can mitigate ferroptosis of ARPE19 cells induced by HG via the miR-200b-3p/CFL2 axis.

Evaluation of the long-term effect of foldable capsular vitreous bodies in severe ocular rupture.

AIM: To evaluate the long-term effect of foldable capsular vitreous body (FCVB) in the treatment of severe ocular rupture to provide a practical basis for clinical selection. METHODS: A total of 26 patients (26 eyes), 23 men and 3 women, with severe ocular rupture who underwent FCVB implantation between March 2018 and September 2018 were retrospectively analysed. All open ocular wounds located in zone III, with preoperative visual acuity grade IV and above (Snellen less than 4/200). The best corrected visual acuity (BCVA), intraocular pressure (IOP), cornea, anterior chamber, iris, lens, choroid, and retina were evaluated before and after the surgery. The subjective feeling and the location of FCVB were also assessed. RESULTS: The average age of the 26 patients was 36y (20-60y). Postoperative follow-up was from 10 to 14mo. At the end of follow up, BCVA was light perception (LP) in 10 cases, no light perception (NLP) in 13 cases, hand motions (HM) in 3 cases. IOP was 11±5 mm Hg. Corneal degeneration was in 3 cases and corneal endothelial dystrophy was in 7 cases. Shallow anterior chamber was in 8 cases and hyphema was in 8 cases. Organized membrane in the pupil was in 14 cases. Epiphora occurred in 3 cases. FCVB drainage tube exposed in 3 cases. All FCVBs were in their normal location and no rejection occurred. CONCLUSION: FCVB implantation is a long-term effective treatment and may provide a practical selection for severe ocular rupture.

Toric markers-assisted implantation of the scleral-fixated intraocular lens.

AIM: To evaluate the efficacy of toric intraocular lens markers-assisted implantation of the scleral-fixated intraocular lens (SFIOL). METHODS: From October 2010 to December 2013, all patients who had undergone secondary SFIOL implantation were assigned to group 1 and 2, in group 1 SFIOL was performed with the assist of radial keratotomy (RK)-marker, and in group 2 SFIOL was performed with the assisted of toric intraocular lens markers (T-and axis markers). Patients' demographic data and information on baseline preoperative visual acuity, indication for surgery and latest postoperative visual acuity were collected and analyzed. The haptic and optic positions were determined by ultrasound biomicroscopy. The optic tilt angle and decentration distance were measured. RESULTS: The study evaluated 43 eyes of 43 patients ranging in age from 3 to 66y. Group 1 comprised 24 eyes (24 patients) and group 2, 19 eyes (19 patients). Uncorrected reoperative acuity was improved on all the eyes postoperatively. The improved postoperative acuity was significantly more in group 2 than that in group 1 (1.11±0.38 vs 0.82±0.45 logMAR; F=4.85, P=0.03). Ultrasonic biomicrograph examination showed that the rate of haptic asymmetry was significantly higher in group 1 (42%, 10/24) than that in group 2 (11%; 2/19) (Chi square=3.68, P=0.04). The mean tilted degree in group 1 was significantly higher than that in group 2 (P=0.04). Mean decentration distance in group 1 was greater than that in group 2 (P=0.03). CONCLUSION: During SFIOL the toric markers help the surgeon identify the placement of fixation more precisely than that with the use of RK marker.

[The mediation of HIF-1α siRNA to the leukocyte adhesion and myeloid cell's activity in rat's retina under early stage of diabetic retinopathy].

OBJECTIVE: To investigate the mediation of HIF-1α siRNA to the leukocyte adhesion and myeloid cell's activity in rat's retina at early stage of diabetic retinopathy. METHODS: Experimental study. HIF-1α specific siRNA expression vector pSUPERH1-siHIF1α was constructed by gene recombination. The rat diabetic model was induced by intraperitoneal injection of streptozotocin. After 2 months of diabetes induction, 27 diabetic rats were randomly chosen and assigned to 3 groups, including diabetes and phosphate buffered saline (PBS) vitreous injection group (group B), diabetes and pSUPERH1-siHIF1α vitreous transfect group (group C) and diabetes and pSUPER-retro vitreous transfect group (group D). Each group had 9 rats. Nine age matched health rats were chosen as control group (group A). Retinal leukostasis was quantified with acridine orange leukocyte fluorography. Retinal myeloid cell activity was measured by enzyme linked immunosorbent assay of myeloperoxidase (MPO). The differences of the mean values among the four groups were analyzed by one-factor analysis of variance. The multiple comparisons of the mean values among the four groups were analyzed by LSD-t analysis. RESULTS: According to the results of the acridine orange leukocyte fluorography, the numbers of leukocyte adhesion in the four groups were (47.00 ± 3.60), (155.33 ± 9.01), (76.00 ± 9.05), (142.66 ± 10.26), respectively. The differences among them were significant (F = 116.25, P = 0.00). The number of leukocyte adhesion in the group C was significantly lower than that in group B (LSD-t test, P = 0.00, 95% CI: 3.56-95.10). The levels of retinal MPO in the four groups were (17.24 ± 1.13), (31.32 ± 2.53), (21.35 ± 1.06), (31.33 ± 1.26) µg/L, respectively. The differences among them were significant (F = 58.68, P = 0.00). The level of retinal MPO in the group C was significantly lower than that in group B (LSD-t test, P = 0.00, 95% CI: 6.92-13.01). CONCLUSIONS: HIF-1α siRNA may play a role in the mediation of the leukocyte adhesion and myeloid cell's activity in rat's retina at early stage of diabetic retinopathy in vivo.

CD18 expression in granulocytes infiltrating the vitreous fluid in patients with diabetic retinopathy.

AIM: To assess the levels of CD18 on the surface of granulocytes infiltrating the vitreous fluid in patients with diabetic retinopathy (DR). METHODS: Vitreous samples from twelve patients with non-proliferative DR with significant macula edema (group A), 33 patients with proliferative DR (grade 3 as group B, n=14, and, grade 4 as group C, n=19) were obtained during pars plana vitrectomy. Vitreous samples from 12 patients with macular hole as controls (group D) were analyzed together. The infiltrating of granulocytes and its surface level of CD18 were measured by flow cytometry. The level of CD18 was presented as the mean channel fluorescence (MCF) on a logarithmic scale. RESULTS: Granulocytes were detected in 6 of 12 vitreous samples from group A, 9 of 14 from group B, 15 of 19 from group C, and none of 12 from group D. MCF of CD18 on granulocytes from groups A, B, and C were 2.978±1.446, 3.201±0.692, and 4.072±0.837, respectively. The difference was significant (F=4.354, P=0.021). Subjects with more severe DR were more likely to have a higher level of CD18 MCF (trend test, χ (2)=7.351, P=0.007). CD18 MCF was significantly associated with the development of DR (r=0.46, P=0.005 and ß=0.147, P=0.035). CONCLUSION: Our results confirm the presence of granulocytes and the elevated levels of CD18 on the surface of them in the vitreous fluid from DR patients. These results may provide indirect evidence shown that granulocytes activation also has occurred in the retinal local compared to non-DR control.

Different expression pattern of serum soluble intercellular adhesion molecules-1 and neutrophilic expression of CD18 in patients with diabetic retinopathy.

AIM: To investigate the levels of serum soluble intercellular adhesion molecules-1(sICAM-1) and neutrophilic expression of CD18 in patients with various stages of diabetic retinopathy and to determine their different expression pattern in the development of diabetic retinopathy(DR). METHODS: Levels of serum sICAM-1 and CD18 on the surface of neutrophile were measured in 41 DR patients, they were classified in three subgroups according to the stage of retinopathy as determined by fund's ophthalmoscopy; 10 control subjects were also studied. sICAM-1 were measured by enzyme-linked immunosorbent assay and CD18 by flow cytometry. RESULTS: The neutrophilic CD18 expression and serum sICAM-1 level were all significantly elevated in all diabetic subgroups compared to control subjects (P<0.01). The differences of CD18 and sICAM-1 among the diabetic subgroups were significant in CD18 but not in sICAM-1. The progression of retinopathy was associated with an increase both in CD18 and in sICAM-1 levels by simple correlation analysis (ß=0.74, P<0.001; ß=0.38, P<0.01, respectively). But stepwise multiple regression analysis revealed that only CD18 was independent determinant of retinopathy (ß=1.04, P<0.01). CONCLUSION: Our results confirm the contribution of endothelial and neutrophilic activation in the development of DR as indicated by increased levels of CD18 and sICAM-1. However, a direct implication of CD18 and ICAM-1 in the progression of DR can be supported only in the CD18 but not ICAM-1. CD18 and ICAM-1 may play different role in the development of diabetic retinopathy.

[Regulatory effects of ninjurin-1 on adhesion of myeloid cells in the retina at the early stage of diabetic rats].

OBJECTIVE: To investigate the regulatory effects of ninjurin-1 on adhesion of myeloid cells in the retina at the early stage of diabetic rats. METHODS: Experimental study. The rat diabetic model was induced by intraperitoneal injection of streptozotocin. After 2 months of diabetes induction, 27 diabetic rats were randomly chosen and assigned to 3 groups, including diabetes and phosphate buffered saline (PBS) injection group (group B), diabetes and anti-Ninj-1 injection group (group C) and diabetes and anti-IgG injection group (group D), with 9 rats in each group. Nine age matched health rats were chosen as control group (group A). Retinal leukostasis was quantified with acridine orange leukocyte fluorography. Retinal myeloid cell infiltration activity was measured by enzyme linked immunosorbent assay of myeloperoxidase (MPO). The differences of the mean values among the four groups were analyzed by one-factor analysis of variance. The multiple comparisons of the mean values among the four groups were analyzed by LSD-t analysis. RESULTS: According to the results of the acridine orange leukocyte fluorography, the numbers of leukocyte adhesion in the four groups were 49.66 ± 13.51, 153.66 ± 20.43, 85.33 ± 15.03 and 156.33 ± 11.53, respectively. The differences among them were significant (F = 143.34, P = 0.000). The numbers of leukocyte adhesion in the group C were significantly lower than that in group B (P = 0.000, 95%CI: -82.68 - -53.98). The levels of retinal MPO in the four groups were (15.66 ± 2.08), (27.66 ± 2.51), (18.02 ± 2.01) and (26.66 ± 3.21) µg/L, respectively. The differences among them were significant (F = 17.61, P = 0.010). The level of retinal MPO in the group C was significantly lower than that in group B (P = 0.010, 95%CI: -14.37 - -4.95). CONCLUSIONS: Ninj-1 may play a role in the mediation of the adhesion of myeloid cell to the rat retina of early-stage of diabetes in vivo.

Effects of repeated injection of intravitreal triamcinolone on macular oedema in central retinal vein occlusion.

PURPOSE: To investigate the effectiveness of repeated injections of intravitreal triamcinolone acetonide (IVTA) in the treatment of macular oedema caused by central retinal vein occlusion (CRVO). METHODS: Seventeen pseudophakic or aphakic eyes of 17 patients (10 male, seven female) with macular oedema caused by CRVO received a repeat injection of 4 mg IVTA, 16 weeks after the first injection of the same dose. The examination included measurements of best-corrected visual acuity (BCVA) for distance and central foveal thickness (CFT) by optical coherence tomography (OCT), preoperatively and 1, 2, 3 and 4 months postoperatively. The values were compared by paired-t test. Side-effects were monitored. RESULTS: BCVA and CFT were not significantly different before initial and repeat injections. Transient improvements of BCVA and CFT were achieved after both injections. At the end of follow-up, BCVA and CFT were significantly different compared to pre-injection values in the same group (P = 0.032, 0.049 in the initial-injection group and P = 0.001, 0.008 in the repeat-injection group, respectively). However, compared to the initial injection, BCVA measurements were significantly worse at each time-point (P = 0.043, 0.011, 0.010 and 0.012, respectively) after the repeat injection, as were CFT at 1, 2 and 3 months post-injection (P = 0.040, 0.015 and 0.025, respectively). The achieved maximum mean intraocular pressures were 20.00 [standard deviation (SD) 2.06] mmHg and 18.56 (SD 3.65) mmHg after the first and repeat injections, respectively. These values were not significantly different (P = 0.467). No other significant adverse events were noted during the study. CONCLUSION: A repeat injection of 4 mg IVTA may not be as effective as an initial injection for the treatment of macular oedema caused by CRVO.

Expression of CD18 on the neutrophils of patients with diabetic retinopathy.

AIM: To investigate the expression of CD18 on neutrophils from patients with various stages of diabetic retinopathy (DR) and to determine the possibility of using it as a marker of disease development. RESEARCH DESIGN AND METHODS: Levels of CD18 on neutrophils were measured by flow cytometry in 10 patients with DR stage 1, 14 patients in stages 2-4, 14 patients in stage 5 and 10 non-diabetic healthy subjects (control). RESULTS: Mean channel fluorescence (MCF) of CD18 on neutrophils from the control, stage 1, stages 2-4 and stage 5 groups were 1.36+/-0.17, 2.99+/-1.44, 3.13+/-1.10 and 4.11+/-1.62, respectively. The difference among them was significant (P=0.00). The highest was from the stage 5 group, then stages 2-4 and stage 1. The least was from the control group (trend test, P=0.00). This trend remained after adjusting for confounding variables. This trend was only significant in type 2 when subjects were divided according to diabetic type, even after adjusting for confounding factors. Multiple linear regression against the level of CD18 MCF by stage of DR and covariates revealed a significant and independent association with the stage of DR (beta=0.33; P=0.01). CONCLUSION: Elevated levels of CD18 on neutrophils were present in each stage of DR in type 2 diabetic patients. The more severe the disease, the higher the level was. CD18 may be a marker of the development of DR in type 2 diabetes.