Prediction model for treatment outcomes 3 years after corneal cross-linking for keratoconus.

PURPOSE: This study aimed to identify preoperative factors that predict visual acuity and Kmax 3 years after corneal cross-linking (CXL) in patients with keratoconus (KC), and to develop a prediction model. METHODS: We enrolled 68 patients with KC and followed up on 100 eyes that received CXL for at least 3 years. Preoperative data, including age, UDVA, CDVA, cylinder, SE, and the parameters of tomography including Kmax were collected as predictors. The primary outcomes were changes in CDVA (Delta CDVA) and Kmax (Delta Kmax) postoperatively. Univariate and multivariate linear regression were used to identify the correlation between the primary outcomes and predictors and establish prediction models. RESULTS: Both CDVA and Kmax remained stable from baseline to 3 years after CXL: from 0.25 ± 0.18 to 0.22 ± 0.20 (P = 0.308) and from 58.70 ± 9.52 D to 57.02 ± 8.83 D (P = 0.187), respectively. Multivariate analysis showed that worse preoperative CDVA (ß coefficient - 0.668, P < 0.001) and lower preoperative Kmean (ß coefficient 0.018,P < 0.001) were associated with greater improvement in CDVA after CXL. A smaller preoperative eccentricity (ß coefficient 8.896, P = 0.01) and a higher preoperative Kmean (ß coefficient - 1.264, P < 0.001) predicted a more flattening of postoperative Kmax. The prediction model for CDVA (R2 = 0.43) and Kmax (R2 = 0.37) could accurately estimate treatment outcomes. CONCLUSIONS: CXL is highly effective in halting or preventing further progression of KC. The preoperative factors CDVA and Kmean were able to predict visual acuity changes 3 years after CXL. And preoperative eccentricity and Kmean could predict Kmax changes 3 years after CXL.

Effect of Si on the Oxidation Behaviors of Ti3 Al1-x Six C2 at 1000 °C.

In this work, Ti3 Al1-x Six C2 (x=0, 0.2, 0.4, and 0.6) with Al/Si solid solution structure are synthesized, and the effects of Si on their oxidation behaviors at 1000 °C are evaluated. The addition of Si not only contributes to the formation of Ti5 Si3 impurity but also affects the composition of the oxide scale. Particularly, the incorporation of Si in the TiO2 lattice is demonstrated, which alters the formation energy of the (110) plane in TiO2 , thus leading to the preferential growth of Si-doped TiO2 to dendritic congeries. Moreover, the Si addition is believed to affect mass transportation during the oxidation process, which accelerates the formation of a continuous Al2 O3 layer in the oxide scale. With an optimized Si content, the oxidation of Ti3 Al1-x Six C2 is restrained. However, with excess Si content, the continuity of the resulting Al2 O3 layer is destroyed, thus the oxidation rate rises again.

Independent-effect comparison of five crosslinking procedures for Progressive Keratoconus based on Keratometry and the ABCD Grading System using Generalized Estimating Equations (GEE).

PURPOSE: Corneal collagen crosslinking (CXL) is an effective treatment for progressive keratoconus. Multiple CXL modalities are clinically available. The present study compared the 1 year outcomes of five types of CXL procedures for progressive keratoconus in a Chinese population using generalized estimating equations (GEE). METHODS: This retrospective study included 239 eyes in 171 patients with keratoconus who underwent CXL and were followed up for 1 year. Five CXL procedures were assessed, including Accelerated Transepithelial CXL, Iontophoresis CXL for 10 min, CXL plus phototherapeutic keratectomy (CXL-plus-PTK), High-Fluence Accelerated CXL, and Accelerated CXL. Patients treated with the Accelerated CXL procedure represented the reference group. Primary outcomes were visual acuity change, spherical equivalence, endothelial cell density, mean keratometry (Kmean), maximum keratometry (Kmax), minimum corneal thickness (MCT), and the ABCD Grading System, consisting of A (staging index for ARC; ARC = anterior radius of curvature), B (staging index for PRC, PRC = posterior radius of curvature), and C (staging index for MCT) values 1 year postoperatively compared to baseline. Secondary outcomes were corrected GEE comparisons from each procedure versus the Accelerated CXL group. RESULTS: The Accelerated Transepithelial CXL group had lower performance than the Accelerated CXL group according to Kmean and Kmax. The CXL-plus-PTK group performed significantly better than the reference group as reflected by Kmax (ß = -0.935, P = 0.03). However, the CXL-plus-PTK group did not perform as well for B and C, and the Iontophoresis CXL group performed better for C. CONCLUSIONS: The CXL-plus-PTK procedure was more effective than the Accelerated CXL procedure based on Kmax, and the Iontophoresis CXL procedure performed better on the C value based on the ABCD Grading System.

The influence of iris -ciliary angle (ICA) on the vault after implantation of V4c implantable collamer lens: a chain mediation model of ICL haptic related factors.

BACKGROUND: This study aims to identify the relationship between iris -ciliary angle (ICA) and the vault. Additionally, we also seek to investigate the chain mediating effects of the ICL haptic related factors on this relationship. METHODS: The participants were categorized into three groups according to the ICA value as follows: low ICA group (< 35°); moderate ICA group (35°-70°); high ICA group (> 70°). We compared the preoperative ocular characteristics and postoperative examinations among the three groups. Multiple variable stepwise regression was performed to establish the vault prediction formula. The Process V4.0 in SPSS and Hayes's PROCESS model 6 was conducted to further elucidate the mediating effects of the final tip point of ICL haptic and the ICL arc-lens arc on the relationship between the ICA and vault. RESULTS: There was a significant difference in the positions of the ICL haptic among three ICA groups. The regression vault equation was Vault = 679.42-7.26*TCA + 192.30*ACD-196.37*CLR + 73.21* STS(horizontal).A significant negative correlation was found between the ICA and vault (P < 0.01).The chain mediation model revealed that the final tip point of ICL haptic and the ICL arc-Lens arc were sequential mediators between ICA and vault (effect = -1.63, 95% CI = -2.72--0.73). CONCLUSION: The ICA was associated with vault via the mediation effect of the final tip point of the ICL haptic and the ICL arc -lens arc. Assessment of ICL haptic related parameters adds significant information to interpret the vault after surgery.

Adverse Events of Intense Pulsed Light Combined With Meibomian Gland Expression Versus Meibomian Gland Expression in the Treatment of Meibomian Gland Dysfunction.

BACKGROUND AND OBJECTIVE: To analyze the occurrence and causes of adverse events (AEs) in intense pulsed light (IPL) combined with meibomian gland expression (MGX) and MGX treatment alone for meibomian gland dysfunction (MGD). STUDY DESIGN/MATERIALS AND METHODS: A retrospective study was conducted on MGD patients treated in Wuhan Aier Hankou Eye Hospital from February 2018 to October 2019 to compare the AEs between IPL-MGX and MGX groups. Relevant AEs that occurred during the treatment and within 1 month after the patients' last treatment were recorded and the causes of the AEs were analyzed. RESULTS: A total of 2,282 patients received IPL-MGX and 1,407 received MGX treatment. No serious AEs occurred in both groups. There were 74 AEs in the IPL-MGX group, with an incidence of 3.24%, including 14 significant AEs (2 cases of epidemic keratoconjunctivitis, 1 recurrent herpes simplex keratitis (HSK), 9 new onsets of floaters, 1 recurrent glaucomatocyclitic crises, and 1 recurrent iridocyclitis). There were 27 AEs in the MGX group with a rate of 1.92%, including 4 significant AEs (2 cases of keratoconjunctivitis epidemic, 2 new cases of floaters). Compared with the IPL-MGX group, the incidence of AEs in the MGX group was lower (P = 0.017). CONCLUSIONS: Both IPL-MGX and MGX treatment are safe therapies with low risk for AEs. IPL treatment is not recommended for young children (age 10 or less) as well as patients with anterior uveitis or glaucomatocyclitic crises. The previous history of HSK and eyes with high myopia are advised to exercise caution in IPL treatment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Spontaneous rotation of a toric implantable collamer lens related to abnormal ciliary body morphology: a case report.

BACKGROUND: This is a case of spontaneous toric implantable collamer lens (TICL) rotation that occurred twice in the left eye of a patient. CASE PRESENTATION: A 24-year-old gentleman received TICL implantation for treatment of myopic astigmatism encountered with spontaneous rotation of approximately 90° from its original position. TICL reposition procedure was performed with visual outcome of 20/16. Surprisingly, a re-rotation of TICL occurred. The patient underwent a replacement of non-toric ICL with a larger size after careful re-evaluation with final visual outcome of 20/20. A short and small ciliary process with shallow ciliary sulcus and posteriorly positioned ciliary body was found by Ultrasound Biomicroscopy (UBM). CONCLUSIONS: The unique morphology of the ciliary body may have a potential association with the vault and instability of implanted ICL. Careful examination of the ciliary body morphology is essential in preoperative evaluation.

Therapeutic effectiveness of different machines in intense pulsed light treatment of meibomian gland dysfunction.

Purpose: This study aimed to determine the therapeutic effectiveness of different machines in intense pulsed light (IPL) treatment of meibomian gland dysfunction (MGD). Methods: 213 subjects diagnosed with MGD underwent three sessions of IPL treatment in a control (M22) treatment group or experimental (OPL-I) treatment group and were followed up three to four weeks after each session. Tear breakup time (TBUT), meibomian gland secretion scores (MGSS), meibomian gland meibum scores (MGMS), corneal fluorescein staining (CFS) scores, and the Standard Patient Evaluation of Eye Dryness (SPEED) was used to assess eye dryness signs and symptoms at baseline and follow-up visits. Results: Two machines had the same working principles except that experimental (OPL-I) group consist of a dual filter system. Both groups showed significant improvements (P â€‹< â€‹0.0001) in TBUT, MGSS, MGMS, CFS scores and SPEED scores. Non-inferiority analysis showed no statistically significant differences in any result between the two groups. Various defects appeared on the filter with the extension of usage time. Spectrophotometry showed that light intensity decreased to 93.5% â€‹± â€‹0.46% past the first filter. Conclusions: IPL treatment completed with different machines have the same effect on improving the symptoms and signs of MGD. The dual filter system in the IPL machine reduces light intensity by approximately 6.5% without affecting its therapeutic effect. It is a feasible measure to ensure double safety and has the significance of popularization not only for MGD but also in other IPL treatment scenarios.

Associations between corneal curvature and other anterior segment biometrics in young myopic adults.

To investigate the associations between corneal curvature (CC) and other anterior segment biometrics in young myopic adults. In this retrospective multi-center study, 7893 young myopic adults were included. CC and other anterior segment biometrics were measured by Scheimpflug imaging (Pentacam). CC was defined as SimK at central 3 mm area, and other anterior segment biometrics included white-to-white corneal diameter (WTW), central corneal thickness (CCT), corneal volume (CV) at 3 mm, 5 mm, and 7 mm area, anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA), anterior corneal eccentricity (ACE) and asphericity (ACAP), posterior corneal eccentricity (PCE) and asphericity (PCAP), anterior chamber depth (ACD), and anterior chamber volume (ACV). Univariate regression analyses were used to assess the associations between CC and other anterior segment biometrics, and multivariate regression analyses were further performed to adjusted for age, gender and spherical equivalent. CC was higher in patients of female gender and higher myopia (all P < 0.05). Eyes in higher CC quartiles had lower WTW, thinner CCT, lower CV at 3 mm and 5 mm, lower ACD, and lower ACV (all P < 0.001), but had larger ACA, larger PCA, less PCE and less PCAP (all P < 0.001), compared to eyes in lower CC quartiles. The trends of CV at 7 mm, ACE and ACAP were inconsistent in different CC quartiles. After adjusting for age, gender and spherical equivalent with multivariate linear regression, CC was positively correlated to CV at 7 mm (ßs = 0.069), ACA (ßs = 0.194), PCA (ßs = 0.187), ACE (ßs = 0.072), PCAP (ßs = 0.087), and ACD (ßs = 0.027) (all P < 0.05), but was negatively correlated to WTW (ßs = - 0.432), CCT (ßs = - 0.087), CV-3 mm (ßs = - 0.066), ACAP (ßs = - 0.043), PCE (ßs = - 0.062), and ACV (ßs = - 0.188) (all P < 0.05). CC was associated with most of the other anterior segment biometrics in young myopic adults. These associations are important for better understanding of the interactions between different anterior segment structures in young myopic patients, and are also useful for the exploration of the pathogenesis of myopia.

Two-stage deep neural network for diagnosing fungal keratitis via in vivo confocal microscopy images.

Timely and effective diagnosis of fungal keratitis (FK) is necessary for suitable treatment and avoiding irreversible vision loss for patients. In vivo confocal microscopy (IVCM) has been widely adopted to guide the FK diagnosis. We present a deep learning framework for diagnosing fungal keratitis using IVCM images to assist ophthalmologists. Inspired by the real diagnostic process, our method employs a two-stage deep architecture for diagnostic predictions based on both image-level and sequence-level information. To the best of our knowledge, we collected the largest dataset with 96,632 IVCM images in total with expert labeling to train and evaluate our method. The specificity and sensitivity of our method in diagnosing FK on the unseen test set achieved 96.65% and 97.57%, comparable or better than experienced ophthalmologists. The network can provide image-level, sequence-level and patient-level diagnostic suggestions to physicians. The results show great promise for assisting ophthalmologists in FK diagnosis.

Ocular biometrics in eyes with different white-to-white corneal diameter in young myopic adults.

The interactions between white-to-white corneal diameter (WTW) and other ocular biometrics are important for planning of refractive surgery and understanding of ocular structural changes in myopia, but such interactions are rarely investigated in young myopic adults. This is a retrospective study involving 7893 young myopic adults from five centers. WTW and other ocular biometrics were measured by Pentacam. The ocular biometrics included anterior corneal curvature (AK) and posterior corneal curvature (PK), central corneal thickness (CCT) and corneal volume (CV), anterior and corneal eccentricity and asphericity, anterior corneal astigmatism (ACA) and posterior corneal astigmatism, anterior chamber depth (ACD), and anterior chamber volume (ACV). The ocular biometrics were compared among eyes of different WTW quartiles. Multivariate linear regression was used to assess the linear associations between WTW and other ocular biometrics adjusting for age, gender and spherical equivalent. In eyes of different WTW quartiles, other ocular biometrics were also significantly different (all P < 0.05). After adjusting for age, gender and spherical equivalent, WTW was positively correlated to AK (ß = 0.26 to 0.29), ACA (ß = 0.13), anterior corneal asphericity (ß = 0.05), PK (ß = 0.33 to 0.34), posterior corneal asphericity (ß = 0.13), ACD (ß = 0.29), and ACV (ß = 40.69), and was negatively correlated to CCT (ß = - 6.83), CV (ß = - 0.06 to - 0.78), anterior corneal eccentricity (ß = - 0.035), and posterior corneal eccentricity (ß = - 0.14) (all P < 0.001). In conclusion, we found that in young myopic adults, larger WTW was associated with thinner corneal thickness, flatter corneal curvature, more anterior corneal toricity, less corneal eccentricity and asphericity, and broader anterior chamber. Our findings may fill in the gap of literature, and help us better understand how the anterior segment structures interact with the WTW in myopia.

Demographic and lifestyle factors associated with dry eye disease in China: A cross-sectional multi-center study.

PURPOSE: Associations were assessed between demographic/lifestyle factors and tear film breakup time (TBUT) defined dry eye disease (DED) in China. METHODS: The cross-sectional study involved 50,280 subjects (54 ± 17 y) in 217 clinics (25 provinces). Data included sleep disorders; digital screen exposure; and use of cosmetics, contact lenses, and eye drops (for asthenopia). Clinical examinations included TBUT; Schirmer I test; meibomian gland plug status. TBUT-defined DED was TBUT <10 s, with TBUT ≤5 s also considered (i.e., short TBUT-type DED), either unilateral or bilateral. RESULTS: TBUT-defined DED was present in 81.6 % overall. The highest rates were in those 71 years or older, living in the north, with chronic daily sleep disorder, or daily cosmetic application; or daily digital screen exposure for 5 years, contact lenses 4 h, or 3 months eye drops. Compared with those without TBUT-defined DED, those with TBUT-defined DED showed lower Schirmer I results and more severe meibomian gland plug status (each, P < 0.001). Independent risk factors of DED were: aging; living in the southwest; daily digital screen exposure ≥3 h; and occasional cosmetic use. Risk factors of DED TBUT ≤5 s were: living in the southwest; wearing contact lenses (>3 y); and using eye drops. Rates of unilateral and bilateral DED were comparable. CONCLUSIONS: DED in China is more likely in the aged and those in the north/southwest. DED rates increase with digital screen exposure, and use of cosmetics, contact lenses, or eye drops for asthenopia. Unilateral DED should be treated as promptly as bilateral.

Varenicline solution nasal spray for dry eye disease in Chinese patients: a randomized phase 3 trial.

Background: Dry eye disease has a high prevalence and exerts a significant negative effect on quality of life. In China, there are currently no available nasal sprays to promote natural tear production in patients with dry eye disease. We therefore evaluated the efficacy and safety of OC-01 (varenicline solution) nasal spray versus vehicle in Chinese patients with dry eye disease. Methods: This was a randomized, multicenter, double-masked, vehicle-controlled, phase 3 clinical trial conducted at ophthalmology departments in 20 hospitals across China (NCT05378945). Eligible patients had a diagnosis of dry eye disease based on patient symptoms, Eye Dryness Score (EDS), Schirmer's Test (with topical anesthesia) Score (STS), and corneal fluorescein staining (CFS) score. Participants were randomly assigned 1:1 using an Interactive Web Response System (IWRS) to receive OC-01 0.6 mg/mL twice daily (BID) or vehicle nasal spray. Participants, investigators, and sponsor were all masked to treatment assignment. The primary endpoint was the percentage of subjects in the intention-to-treat population achieving ≥10 mm improvement in STS from baseline at week 4. Findings: In total, 340 patients were randomized from 21 July 2022 to 04 April 2023, 78.8% were female. Patients in the OC-01 group (n = 176) had significantly higher achievement of ≥10 mm improvement in STS (35.8% [n = 63] versus 17.7% [n = 29], stratified odds ratio: 2.67, 95% CI: 1.570-4.533, p = 0.0002) and a significantly greater increase from baseline STS (least-squares mean difference [SE]: 3.87 [0.794], p < 0.0001) at week 4 versus the vehicle group (n = 164). In addition, OC-01 led to a numerically greater reduction in mean EDS from baseline at week 4 compared to the vehicle group (LS mean [SE] difference: -1.3 [2.20]; 95% CI: -5.64 to 2.99, p = 0.5467). The most common adverse event was mild, transient sneezing (78% of OC-01 administrations). No serious adverse events related to nasal administration occurred. Interpretation: OC-01 (varenicline solution) nasal spray BID has clinically meaningful efficacy for reducing the signs (as measured by STS) and may improve the symptoms (as measured by EDS) of dry eye disease, with an excellent safety and tolerability profile, in the Chinese population. Funding: Jixing Pharmaceutical Co. Ltd.

Characteristics and factors associated with the position of the haptic after ICL V4C implantation.

PURPOSE: To assess the position of implantable collamer lens (ICL) haptic after ICL V4C implantation using standardized panoramic ultrasound bimicroscopy (UBM), to analyze its characteristics, associated factors, and the relationship with the clinical vault quantitatively. SETTING: Hankou Aier Eye Hospital, Wuhan, Hubei, China. DESIGN: Cross-sectional study. METHODS: 167 subjects (323 eyes) implanted with ICL V4C who had a 3-month follow-up with UBM examination were included in this study. The relative position of ICL to the adjacent structure and ICL haptic-related parameters (the final tip point of ICL haptic [ftICL haptic], measured from the scleral spur to the final tip of the ICL haptic, the posterior of the ICL to ICL haptic [ICL arc], measured from the posterior surface of the ICL to the ICL haptic plane, and the height of the crystalline lens from the ICL haptic (lens arc), measured from the anterior surface of the crystalline lens to the ICL haptic plane and other parameters), were estimated on the UBM image. Eyes were divided into 3 subgroups according to the ftICL haptic (Group 1: ≤0.5 mm; Group 2: 0.5 to 1.0 mm; and Group 3:≥1.0 mm, respectively), and the factors associated with the ICL haptic-related parameters and their impact on the clinical vault were evaluated. RESULTS: The haptics could be imaged in the ciliary sulcus, on the ciliary body, and under the ciliary body in 629 (48.7%), 525 (40.6%), and 138 (10.7%) eyes, respectively. The ftICL haptic and the summation of ICL arc and lens arc showed a correlation with the clinical vault ( r = -0.34, P = .00; r = 0.87, P = .00). When the ftICL haptic results were divided into 3 groups, the percentage of eyes that exhibited clinical vault >750 µm were lowest in Group 3. Multivariate regression analysis showed spherical equivalent, white-to-white (WTW), anterior chamber volume (ACV) and iris-ciliary angle (ICA); the difference between the implanted ICL size and horizontal sulcus-to-sulcus (ICL size-STS) were associated with the ftICL haptic. The IOP, WTW, ACV, and the ICL size-STS were significantly associated with ICL arc, while the ICA and lens rise were associated with lens arc. CONCLUSIONS: The position of ICL haptic was associated with the clinical vault. Its quantitative evaluation may provide valuable information to help clinicians to select the best ICL size before surgery and understand the formation of clinical vault after surgery.

Development and validation to predict visual acuity and keratometry two years after corneal crosslinking with progressive keratoconus by machine learning.

Purpose: To explore and validate the utility of machine learning (ML) methods using a limited sample size to predict changes in visual acuity and keratometry 2 years following corneal crosslinking (CXL) for progressive keratoconus. Methods: The study included all consecutive patients with progressive keratoconus who underwent CXL from July 2014 to December 2020, with a 2 year follow-up period before July 2022 to develop the model. Variables collected included patient demographics, visual acuity, spherical equivalence, and Pentacam parameters. Available case data were divided into training and testing data sets. Three ML models were evaluated based on their performance in predicting case corrected distance visual acuity (CDVA) and maximum keratometry (Kmax) changes compared to actual values, as indicated by average root mean squared error (RMSE) and R-squared (R2) values. Patients followed from July 2022 to December 2022 were included in the validation set. Results: A total of 277 eyes from 195 patients were included in training and testing sets and 43 eyes from 35 patients were included in the validation set. The baseline CDVA (26.7%) and the ratio of steep keratometry to flat keratometry (K2/K1; 13.8%) were closely associated with case CDVA changes. The baseline ratio of Kmax to mean keratometry (Kmax/Kmean; 20.9%) was closely associated with case Kmax changes. Using these metrics, the best-performing ML model was XGBoost, which produced predicted values closest to the actual values for both CDVA and Kmax changes in testing set (R2 = 0.9993 and 0.9888) and validation set (R2 = 0.8956 and 0.8382). Conclusion: Application of a ML approach using XGBoost, and incorporation of identifiable parameters, considerably improved variation prediction accuracy of both CDVA and Kmax 2 years after CXL for treatment of progressive keratoconus.

A literature-derived dataset on risk factors for dry eye disease.

Dry eye disease (DED) is a common disease associated with disorder of tear secretion. Research on risk factors for DED, such as depression, arthritis, thyroid disease, stroke and diabetes, is important to facilitate its diagnosis and prognosis. We created a dataset on risk factors for DED (DrDED) with public access that can provide up-to-date and validated data acquired from systematically searched and screened, high-quality studies. The established DrDED contained 119 studies published between 2000 and 2022. The range of the study sample size was from 43 to 4,871,504. The study types were, as follows: cross-sectional (n = 92), retrospective cohort (n = 9), prospective cohort (n = 10), and case-control (n = 8) studies. Data from eligible studies were collected and presented for the present study, including the publication information, study characteristics, definition and prevalence of the disease, and risk factors for DED, together with the strength of association. With the publication of new relevant studies, the DrDED will be updated, and the data will be made accessible to the users. Design Type(s) Dataset creation objective Measurement Type(s) Patient outcome • scientific publication • risk factors • dry eye disease Technology Type(s) Digital curation • documenting • meta-analysis Factor Type(s) Depression • arthritis • thyroid disease • stroke disease • diabetes Sample Characteristic(s) Homo sapiens • dry eye disease • global.

Intraoperative malignant glaucoma during femtosecond laser-assisted cataract surgery: A case report.

RATIONALE: Femtosecond laser-assisted cataract surgery (FLACS) has grown in popularity among ophthalmologists as a novel surgical technique. However, malignant glaucoma (MG) is a complication of FLACS. Herein, we report a case of MG following FLACS. PATIENT CONCERNS: A 66-year-old woman presented with complaints of blurred vision in the right eye and a foreign body sensation in both eyes. Ophthalmological examinations showed that the corrected distance visual acuity was 20/50 and 20/25 in the right and left eyes, respectively. Without any topical anti-glaucoma medication, the intraocular pressure (IOP) was 20 mmHg in the right eye and 17 mmHg in the left eye. Slit-lamp examination of the right eye revealed a transparent cornea with a defect in the punctate overlying epithelium; the central anterior chamber depth was shallow the peripheral iris laser shot was visible, the pupil was normal, and the lens was mainly cortical opacified. DIAGNOSES: Based on the patient's symptoms, examination results, and preliminary diagnoses, age-related cataract in the right eye, binocular post-antiglaucoma surgery, pseudophakicin in the left eye, and Sjogren syndrome were included. INTERVENTIONS: FLACS was performed to facilitate anterior capsulotomy and segmentation of the nucleus in the right eye. MG occurred after the femtosecond procedure, and with the treatment of medicines combined with phacoemulsification, IOP was eventually normal without further antiglaucoma therapy. OUTCOMES: IOP was 16 mmHg on postoperative day 1. Ocular ultrasonography revealed no choroid detachment or hemorrhage in the right eye. Two weeks postoperatively, uncorrected visual acuity was 20/25, and IOP remained normal with no further antiglaucoma treatment on 1 month postoperatively. CONCLUSIONS: We describe the occurrence of MG after FLACS and illustrate that miosis and bubble formation after FLACS may be risk factors for MG during FLACS.

Transient response of bridge piers under eccentric impact of near-fault earthquake.

To study the influence of near-fault earthquake on pier failure, establish a double-span continuous girder bridge. The seismic response of the bridge is calculated using the transient wave function expansion method and the indirect mode function superposition method. Solve the dynamic and displacement responses, and the effect of the vertical separation of the bridge on the eccentric compression of the pier is analyzed. The results show that under the near-fault vertical seismic action, the separation can significantly change the horizontal deformation at the top of the pier, and neglecting the separation may underestimate the eccentric compression of the pier. Calculations for different pier heights and girder spans show that separation has a greater effect on the longitudinal deformation of the pier top. Therefore, the reasonable design of longitudinal limit device on pier top in the near-fault area is helpful to reduce the damage of eccentric bridge impact.

Can Psychological Contracts Decrease Opportunistic Behaviors?

Behavioral psychology is increasingly important in relationship marketing. As key factors of emotional interactions between buyer and seller, psychological contracts and opportunistic behaviors play a critical role in interorganizational relationships which are based on personal relationships of boundary spanners and top management. Most of the existing research mainly focus on positive performance of cooperation but ignoring the dark side of relationships. This study introduces the psychological contract into the exploration of why formal contracts cannot completely avoid opportunistic behaviors. It mainly investigates whether psychological contracts in relationships can reduce the occurrence of opportunistic behaviors. The results show that psychological contract has a significant positive effect on the relationship quality, and negatively affect opportunistic behavior through trust and commitment. The positive relationship between psychological contracts and relationship quality is moderated by dependence. This study enriches and expands the domestic and foreign research on psychological contracts and opportunistic behaviors in relationship marketing.

Detection of subclinical keratoconus using a novel combined tomographic and biomechanical model based on an automated decision tree.

Early detection of keratoconus is a crucial factor in monitoring its progression and making the decision to perform refractive surgery. The aim of this study was to use the decision tree technique in the classification and prediction of subclinical keratoconus (SKC). A total of 194 eyes (including 105 normal eyes and 89 with SKC) were included in the double-center retrospective study. Data were separately used for training and validation databases. The baseline variables were derived from tomography and biomechanical imaging. The decision tree models were generated using Chi-square automatic interaction detection (CHAID) and classification and regression tree (CART) algorithms based on the training database. The discriminating rules of the CART model selected metrics of the Belin/Ambrósio deviation (BAD-D), stiffness parameter at first applanation (SPA1), back eccentricity (Becc), and maximum pachymetric progression index in that order; On the other hand, the CHAID model selected BAD-D, deformation amplitude ratio, SPA1, and Becc. Further, the CART model allowed for discrimination between normal and SKC eyes with 92.2% accuracy, which was higher than that of the CHAID model (88.3%), BAD-D (82.0%), Corvis biomechanical index (CBI, 77.3%), and tomographic and biomechanical index (TBI, 78.1%). The discriminating performance of the CART model was validated with 92.4% accuracy, while the CHAID model was validated with 86.4% accuracy in the validation database. Thus, the CART model using tomography and biomechanical imaging was an excellent model for SKC screening and provided easy-to-understand discriminating rules.

Degradable and self-luminescence porous silicon particles as tissue adhesive for wound closure, monitoring and accelerating wound healing.

Tissue adhesives have received much attention for their effectiveness in sealing wounds or incisions in clinical surgery, especially in minimally invasive surgery. To meet the safe and smart wound management requirements, ideal tissue adhesives are expected to have high biocompatibility, and be able to accelerate wound closing and healing, and monitor wound healing process. However, few adhesives fit all of the above descriptions. It has been demonstrated that inorganic nanoparticles can directly glue biological tissue based on nano-bridging effect. In this study, self-luminescence porous silicon (LPSi) particles were prepared with degradable and biocompatible properties. In addition, the self-luminescence property of LPSi particles was discovered by In Vivo Imaging System (IVIS) for the first time, which can avoid the limitations of photoluminescence imaging. Due to the oxidation and degradation reaction, LPSi particles not only can be degraded completely in several days, but also showed satisfactory biocompatibility. And their degradation product could promote tube formation of HUVECs. Moreover, owing to the high specific surface area and the outer oxide layer of LPSi particles, LPSi tissue adhesive exhibited strong adhesive strength to pig livers. Furthermore, this adhesive closed wound rapidly, promoted angiogenesis and epidermal regeneration, and facilitated wound healing in a mouse skin incision model. Importantly, the wound healing ratio can be monitored by measuring the self-luminescence intensity of LPSi particles in the wound site. This study reveals that LPSi particles could be employed as a safe and smart wound management tissue adhesive for wound closure, as well as accelerating and monitoring wound healing.