Vault predicting after implantable collamer lens implantation using random forest network based on different features in ultrasound biomicroscopy images.

AIM: To analyze ultrasound biomicroscopy (UBM) images using random forest network to find new features to make predictions about vault after implantable collamer lens (ICL) implantation. METHODS: A total of 450 UBM images were collected from the Lixiang Eye Hospital to provide the patient's preoperative parameters as well as the vault of the ICL after implantation. The vault was set as the prediction target, and the input elements were mainly ciliary sulcus shape parameters, which included 6 angular parameters, 2 area parameters, and 2 parameters, distance between ciliary sulci, and anterior chamber height. A random forest regression model was applied to predict the vault, with the number of base estimators (n_estimators) of 2000, the maximum tree depth (max_depth) of 17, the number of tree features (max_features) of Auto, and the random state (random_state) of 40.0. RESULTS: Among the parameters selected in this study, the distance between ciliary sulci had a greater importance proportion, reaching 52% before parameter optimization is performed, and other features had less influence, with an importance proportion of about 5%. The importance of the distance between the ciliary sulci increased to 53% after parameter optimization, and the importance of angle 3 and area 1 increased to 5% and 8% respectively, while the importance of the other parameters remained unchanged, and the distance between the ciliary sulci was considered the most important feature. Other features, although they accounted for a relatively small proportion, also had an impact on the vault prediction. After parameter optimization, the best prediction results were obtained, with a predicted mean value of 763.688 µm and an actual mean value of 776.9304 µm. The R2 was 0.4456 and the root mean square error was 201.5166. CONCLUSION: A study based on UBM images using random forest network can be performed for prediction of the vault after ICL implantation and can provide some reference for ICL size selection.

Validation of the vault prediction model based on the sulcus-to-sulcus diameter and lens thickness: a 925-eye prospective study.

BACKGROUND: To verify the accuracy and stability of the prediction formula based on the ciliary sulcus diameter and lens thickness and to analyse factors influencing the prediction results. METHODS: In total, 925 eyes from 506 subjects were enrolled in this prospective study between July 1, 2020, and June 30, 2021. Subjects were divided into four seasons, each spanning three months. The target vault was set to be between 300 µm and 700 µm according the prediction formula. The actual vault was measured one month postoperatively. The Bland-Altman test, 95% confidence intervals (95% CI) and 95% limits of agreement (95% LoA) were used to evaluate the agreement between the predicted vault and the actual vault. Eyes with absolute prediction errors greater than 300 µm were further analysed. RESULTS: The mean predicted vaults for the four seasons were 503 ± 99, 494 ± 96, 481 ± 92 and 502 ± 93 µm, while the mean actual vaults were 531 ± 189, 491 ± 179, 464 ± 179 and 529 ± 162 µm, respectively. The predicted and actual vaults of the overall subjects were 493 ± 95 and 500 ± 180 µm, respectively. Of the 925 eyes, 861 eyes (93.08%), 42 eyes (4.54%), and 22 eyes (2.38%) showed a normal vault, high vault, and low vault, respectively. Bland-Altman plots showed that the mean difference between the actual vault and predicted vault overall (± 95% LoA) was 6.43 ± 176.2 µm (-339 to 352 µm). Three UBM features may lead to large prediction errors (more than 300 µm): wide iris-ciliary angle (ICA), iris concavity and anteriorly positioned ciliary body. CONCLUSIONS: This study demonstrated the accuracy and stability of the prediction formula through the validation of a large sample size and a long time span. Wide ICA, iris concavity and anteriorly positioned ciliary body may have an effect on vault.

A prediction model for sulcus-to-sulcus diameter in myopic eyes: a 1466-sample retrospective study.

BACKGROUND: To establish and verify the accuracy and reliability of a sulcus-to-sulcus diameter (STS) prediction model. METHODS: In this retrospective study, the prediction formula was established with the data from 1466 eyes from 733 subjects from July 2020 to April 2021 and verified with the data from 278 eyes from 139 subjects between May 2021 and June 2021. Each subject was measured with a Pentacam, IOLMaster 700, OPD-Scan III, and ultrasound biomicroscope. The prediction formulas were established with multiple linear regression, and intergroup correlation coefficients (ICCs) and Bland-Altman tests were used to assess the agreement between the predicted and actual STS (actual STS was measured by UBM). RESULTS: The explanatory variables relevant to the horizontal STS (STSH) were the Pentacam white-to-white diameter (WTWP; standardized partial regression coefficient [ß] = 0.330; p < 0.001), the flat K value (ß = -0.211; p < 0.001), and the anterior corneal diameter (ACD) (ß = 0.178; p < 0.001). The corresponding multiple regression equation was : STSH (mm) = 8.061 + 0.510 × WTWP - 0.090 × Flat K value + 0.430 × ACD. The explanatory variables relevant to the vertical STS (STSV) were the WTWP (ß = 0.435; p < 0.001), the steep K value (ß = -0.271; p < 0.001), and the ACD (ß = 0.187; p < 0.001). The corresponding multiple regression equation was : STSV (mm) = 8.540 + 0.492 × WTWP - 0.075 × Steep K value + 0.329 × ACD. The bias of the predicted to the actual STSH was - 0.021, with 95% limits of agreement (95% LoA) from - 0.499 to 0.457. The bias of the predicted to the actual STSV was 0.057, with 95% LoA from - 0.462 to 0.575. The ICC was 0.883 between the predicted and actual STSH and 0.859 between the predicted and actual STSV. CONCLUSIONS: The Pentacam-measured WTW, the K value and the ACD are important for predicting the STS diameter. The prediction model has good accuracy and reliability. TRIAL REGISTRATION: Not applicable.

Short-term changes in and preoperative factors affecting vaulting after posterior chamber phakic Implantable Collamer Lens implantation.

BACKGROUND: To describe the very early vault changes in the first month after Implantable Collamer Lens (ICL) implantation and to evaluate the effect of preoperative biometric factors on vault. METHODS: Eighty-three eyes from eighty-three subjects with complete data who met follow-up requirements were recruited in this retrospective study between May 2019 and March 2020. We quantitatively assessed the postoperative vault at 2 h, 1 day, 1 week, and 1 month following implantation. Associations between the postoperative vault and age, ICL size, spherical equivalent (SE), axial length (AL), central corneal thickness (CCT), flat keratometry (K), steep K, mean K, anterior chamber depth (ACD), crystalline lens thickness (LT), white-to-white (WTW) diameter obtained by three devices, horizontal and vertical sulcus-to-sulcus (STS) diameter, bright and dark pupil sizes (BPS and DPS) and DPS-BPS were investigated using Spearman's correlation analysis and stepwise multiple regression analysis. RESULTS: The mean vault values at 2 h, 1 day, 1 week, and 1 month after ICL implantation were 672.05 ± 30.72, 389.15 ± 28.33, 517.23 ± 30.76 and 530.12 ± 30.22 µm, respectively. Significant differences were found in the vault values at 2 h, 1 day and 1 week after the operation. The ICL size (ß = 0.942; p < 0.001), followed by horizontal STS (ß = -0.517; p < 0.001), crystalline LT (ß = -0.376; p < 0.001) and vertical STS (ß = -0.257; p = 0.017), significantly influenced the vault at 1 month after the operation. The multiple regression equation was expressed as follows: central vault (µm) = -1369.05 + 657.121 × ICL size- 287.408 × horizontal STS - 432.497 × crystalline LT - 137.33 × vertical STS (adjusted R2 = 0.643). CONCLUSIONS: After ICL implantation, the vault decreased and then increased, but it did not return to the vault value 2 h after surgery. The ICL size, horizontal and vertical STS and crystalline LT are key factors for predicting postoperative vaulting.

Melatonin attenuates oxidative stress and inflammation of Müller cells in diabetic retinopathy via activating the Sirt1 pathway.

Oxidative stress and inflammation are important pathogenic factors of diabetic retinopathy (DR). DR remains the most common ocular complication caused by diabetes mellitus (DM) and is the leading cause of visual impairment in working-aged people worldwide. Melatonin has attracted extensive attention due to its potent antioxidant and anti-inflammatory effects. In the present study, melatonin inhibited oxidative stress and inflammation by enhancing the expression and activity of silent information regulator factor 2-related enzyme 1 (Sirt1) both in in vitro and in vivo models of DR, and the Sirt1 inhibitor EX-527 counteracted melatonin-mediated antioxidant and anti-inflammatory effects on Müller cells. Moreover, melatonin enhanced Sirt1 activity through the maternally expressed gene 3 (MEG3)/miR-204 axis, leading to the deacetylation of the Sirt1 target genes forkhead box o1 (Foxo1) and nuclear factor kappa B (NF-κB) subunit p65, eventually contribute to the alleviation of oxidative stress and inflammation. The study revealed that melatonin promotes the Sirt1 pathway, thereby protecting the retina from DM-induced damage.

Analysis of macular microvasculature and thickness after ICL implantation in patients with myopia using optical coherence tomography.

AIM: To investigate changes in macular vessels and thickness in myopic eyes after intraocular collamer lens (ICL) implantation using quantitative optical coherence tomography angiography (OCTA). METHODS: This retrospective included 73 myopic eyes of 73 patients (average age, 27.53±6.16y) who underwent ICL implantation (28 eyes were Toric ICL). Axial length (AL), uncorrected visual acuity (UCVA), refractive dioptre (RD), intraocular pressure (IOP) and OCTA were measured and compared with before and 1wk, 1, and 3mo after surgery. OCTA was used to image vessel density (VD) and skeleton density (SD) in both the superficial (SCP) and deep capillary plexus (DCP). Central retinal thickness (CRT) and ganglion cell-inner plexiform layer thickness (GCT) were also measured. Changes between pre- and postoperative measurements were analysed by repeated measures analysis of variance. RESULTS: Compared with preoperative data, postoperative data on UCVA revealed significant improvements in all patients (P<0.05). However, there was no significant difference in IOP. After the operation, CRT and GCT exhibited significant changes (P<0.05). Among these measures, CRT was significantly higher at one and three months postoperative (all P<0.01). GCT was significantly higher at 1wk, 1, and 3mo postoperative (all P<0.01). Changes in VD and SD were nonsignificant in both the SCP and DCP. There was no difference in postoperative changes between the ICL and Toric ICL groups. CONCLUSION: ICL and Toric ICL implantation both have good efficacy and safety for myopic eyes, but macular area changes that occur after surgery need attention.

Long non-coding RNA MEG3 promotes cataractogenesis by upregulating TP53INP1 expression in age-related cataract.

Age-related cataract (ARC) is the leading cause of visual impairment or even blindness among the aged population globally. Long non-coding RNA (LncRNA) has been proven to be the potential regulator of ARC. The latest study reveals that maternally expressed gene 3 (MEG3) promotes the apoptosis and inhibits the proliferation of multiple cancer cells. However, the expression and role of MEG3 in ARC are unclear. In this study, we investigated the effects of MEG3 in ARC and explored the regulatory mechanisms underlying these effects. We observed that MEG3 expression was up-regulated in the age-related cortical cataract (ARCC) lens capsules and positively correlated with the histological degree of ARCC. The pro-apoptosis protein, active caspase-3 and Bax increased in the anterior lens capsules of ARCC tissue, while the anti-apoptotic protein Bcl-2 decreased compared to normal lens. Knockdown of MEG3 increased the viability and inhibited the apoptosis of LECs upon the oxidative stress induced by H2O2. MEG3 was localized in both nucleus and cytoplasm in LECs. MEG3 facilitated TP53INP1 expression via acting as miR-223 sponge and promoting P53 expression. Additionally, TP53INP1 knockdown alleviated H2O2-induced lens turbidity. In summary, MEG3 promoted ARC progression by up-regulating TP53INP1 expression through suppressing miR-223 and promoting P53 expression, which would provide a novel insight into the pathogenesis of ARC.

Characterization of the Three Distinct Retinal Capillary Plexuses Using Optical Coherence Tomography Angiography in Myopic Eyes.

Purpose: To segment and quantify three distinct retinal capillary plexuses using optical coherence tomography angiography (OCTA) in myopic eyes. Methods: We analyzed 96 eyes from 62 subjects with myopia (27.76 ± 7.05 years of age) and evaluated 30 normal eyes from 15 subjects (28.33 ± 3.13 years of age) for controls. En face OCTA images generated by AngioPlex (Carl Zeiss; Oberkochen, Germany) were manually segmented by the progressive matching method into superficial, middle, and deep capillary plexuses (SCPs, MCPs, and DCPs, respectively). Estimated positions for each plexus relative to the reference line were calculated. After strict artifact removal and magnification correction, vessel density (VD) and skeleton density (SD) analyses were performed on each capillary plexus. Results: Myopic eyes were divided into three groups according to their degree of myopia. We defined the relative estimated positions of the MCP outer boundary to the retinal pigment epithelium fit layer as MCP = -89.317 - 0.178 (central retinal thickness) - 0.580 (ganglion cell inner plexiform thickness); the DCP outer boundary was 38.48 ± 6.24 µm below the inner plexiform layer. VDs were significantly higher in the super-high myopia group than in the control and moderate myopia groups for the DCP (all P < 0.05). SDs in the SCPs were significantly lower in the high myopia and super-high myopia groups than in the control groups (all P < 0.001). Conclusions: With progressive matching, we segmented three capillary plexuses and defined the relative estimated positions of each capillary plexus to the reference line in myopic eyes. The VD of the DCP increased for more myopic eyes. Translational Relevance: Our study provides a visual method for OCTA image vascular segmentation for myopic eyes.

Clinical Effect and Rotational Stability of TICL in the Treatment of Myopic Astigmatism.

PURPOSE: To investigate the clinical outcomes and possible risk factors associated with rotational stability after the implantation of a V4c toric implantable Collamer lens (TICL) for the correction of moderate to high myopic astigmatism. METHODS: A total of 112 eyes of 66 patients with moderate to high myopic astigmatism underwent TICL implantation. All patients were followed up for more than 1 year. The uncorrected and best-corrected visual acuity (UCVA and BCVA), astigmatism and spherical equivalent, intraocular pressure, vault, endothelial cell morphometry, and rotation of the TICL axis were assessed at l day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively. Postoperative rotation was defined as the angle between the intended axis and the achieved axis. Regression analysis was used to investigate the possible risk factors for TICL rotation postoperatively. RESULTS: The mean efficacy index and safety index 12 months postoperatively were 1.03 ± 0.09 and 1.05 ± 0.10, respectively. All patients had the same or better visual acuity than preoperatively. The mean astigmatism value decreased from -1.86 ± 0.79 D preoperatively to -0.37 ± 0.35 D. The mean absolute axis deviation of the TICL at the last follow-up was 2.75 ± 2.04° (range, 0°âˆ¼11°). The mean manifest refraction spherical equivalent (MRSE) changed from -9.04 ± 2.67 D preoperatively to -0.67 ± 0.51 D postoperatively. The logistic regression demonstrated that the absolute degree of TICL rotation had a significant association with the fixation angle of the TICL and the size of the lens (P=0.003, P=0.026, resp.). CONCLUSION: The results of our study support that TICL implantation is safe, effective, and predictable in the treatment of moderate to high myopic astigmatism, with relatively good postoperative rotational stability.

A New Approach for the Segmentation of Three Distinct Retinal Capillary Plexuses Using Optical Coherence Tomography Angiography.

PURPOSE: To segment three distinct retinal capillary plexuses by using optical coherence tomography angiography (OCTA). METHODS: This prospective study included 30 eyes of 15 healthy subjects. En face OCTA images generated by the AngioPlex platform were manually segmented by the "progressive matching" method to the superficial, middle, and deep capillary plexuses (SCP, MCP, and DCP, respectively). The estimated position of each plexus relative to the reference line was calculated. Vascular density (VD) and skeleton density (SD) analyses, as well as the interclass correlation coefficient and relative standard deviation, were performed on each capillary plexus. We also measured central retinal thickness (CRT) and ganglion cell layer thickness (GCT). RESULTS: Thirty eyes of 15 healthy subjects (9 females; average age of 28.33 ± 3.07 years) were included in the analysis. We defined the relative estimated positions of the outer boundary MCP to the RPEfit as MCP = 14.491 - 0.307 CRT - 1.443 GCT, while the outer boundary of DCP was 37.63 ± 7.04 µm below the IPL. The VDs of SCP, MCP, and DCP were 32.97% ± 3.90%, 45.05% ± 5.34%, and 37.34% ± 4.96%, respectively, while the SDs of SCP, MCP, and DCP were 14.45 ± 1.51 mm-1, 19.80 ± 1.92 mm-1, and 17.38 ± 1.97 mm-1, respectively. CONCLUSIONS: With the progressive matching method, we segmented three capillary plexuses and defined the relative estimated positions of each capillary plexus to the reference line and calculated the VD and SD of three capillary plexuses in healthy subjects, providing controls for future studies. TRANSLATIONAL RELEVANCE: Our study provides a visual method for OCTA image vascular segmentation and provides reference and control for future studies on retinal three capillary plexuses.

LncRNA FEZF1-AS1 Promotes TGF-ß2-Mediated Proliferation and Migration in Human Lens Epithelial Cells SRA01/04.

Posterior capsule opacification (PCO) is a common complication after cataract surgery attributed to the proliferation and migration of postoperative residual lens epithelial cells (LECs). The long noncoding RNA (lncRNA) FEZ family zinc finger 1 antisense RNA 1 (FEZF1-AS1) promotes the proliferation and migration of multiple types of cancer cells. Here, we discovered that FEZF1-AS1 is markedly upregulated in TGF-ß2-treated SRA01/04 cells. In addition, the proliferation and migration of SRA01/04 cells were enhanced following TGF-ß2 treatment. FEZF1-AS1 knockdown inhibited the TGF-ß2-induced proliferation and migration of SRA01/04 cells. Accordingly, FEZF1-AS1 overexpression promoted the TGF-ß2-induced proliferation and migration of SRA01/04 cells. Finally, FEZF1-AS1 upregulated TGF-ß2-induced SRA01/04 cell proliferation and migration via boosting FEZF1 protein levels. Our findings indicate that the dysregulation of FEZF1-AS1 participates in the TGF-ß2-induced proliferation and migration of human lens epithelial cells (HLECs), which might be achieved, at least in part, through the induction of FEZF1 expression.

Intravitreal Ets1 siRNA alleviates choroidal neovascularization in a mouse model of age-related macular degeneration.

Choroidal neovascularization (CNV) is the basic feature of neovascular age-related macular degeneration (AMD), the leading cause of blindness in elders. Macrophages and microglia promote CNV via producing pro-angiogenic factors and inflammatory cytokines. Transcription factor E26 transformation specific-1 (Ets1) plays a pro-angiogenic role via its pro-inflammatory function. In this study, Ets1 increased and localized in the macrophages and microglia of a mouse laser-induced CNV region. Ets1 siRNA intravitreal injection ameliorated the leakage and area of CNV, as well as inhibiting the dysfunction of retinal pigment epithelium (RPE) cells and the activation of macrophages/microglia. Taken together, we provide a new insight into the molecular mechanism of CNV progression, in which Ets1 can be a new therapeutic target.