Visual outcomes and patient satisfaction after implantations of three types of presbyopia-correcting intraocular lenses that have undergone corneal refractive surgery.

This prospective, non-randomized, comparative study aimed to compare the visual outcomes and patient satisfaction after implantations of three presbyopia-correcting intraocular lenses (IOLs) after myopic refractive surgery. It was conducted from January 2020 to December 2021 in Shanghai Heping Eye Hospital. Patients were divided into three groups based on the type of IOL implanted. The visual acuity, refractive stability, high-order aberrations, objective visual quality, spectacle independence, and visual function index 14 questionnaire scores of the three groups were compared. This study included 78 eyes of 39 patients: 26 eyes with 839MP, 26 eyes with MF30, and 26 eyes with ZXR00. Uncorrected distance visual acuity improved significantly for all three groups. For a pupil diameter of 4.0 mm, the spherical aberrations of the three groups were 0.33 ± 0.16 µ, 0.50 ± 0.08 µ, and 0.39 ± 0.10 µ, respectively. The spectacle independence for distance vision was over 90% in each group; for near vision, it was only 25% for the ZXR00 group. All three types of presbyopia-correcting IOLs improved visual quality in post-LASIK or PRK patients. However, the high incidence of photic phenomena after presbyopia-correcting IOL implantation in patients who have undergone myopic LASIK should not be neglected.

Comparison of astigmatism correction and visual outcomes in mix-and-match implantations of trifocal intraocular lenses with femtosecond laser-assisted arcuate keratotomy and contralateral bifocal Toric intraocular lenses.

Introduction: Astigmatism reduces the postoperative visual performance after non-toric intraocular lenses (IOLs) implantation, and limits the use of refractive IOLs in cataract surgery. The purpose of this study was to compare the efficacy in astigmatism correction and the postoperative visual outcomes between the implantation of a trifocal IOL with femtosecond laser-assisted arcuate keratotomy (FSAK) in one eye and a bifocal toric IOL (TIOL) in the other, in patients with cataract and moderate astigmatism. Methods: This prospective observational paired-eye study enrolled patients with cataract and corneal astigmatism (CA) between 0.75 and 2.25 D in both eyes. The patients underwent a mix-and-match treatment comprising trifocal IOL implantation with FSAK and bifocal TIOL implantation. We compared the visual acuity (VA) at all distances, defocus curve, postoperative refractive astigmatism (RfA), CA, high-order aberrations, modulation transfer function (MTF) curve, and Strehl ratio between the two eye groups. Results: In total, 41 patients (82 eyes) were enrolled and completed a 6-month follow-up. The 1- and 3-month uncorrected distance VA and 3-month uncorrected near VA were greater in eyes with bifocal TIOLs than with trifocal IOLs and FSAK (p = 0.036, 0.010, and 0.030, respectively), whereas the latter had greater uncorrected intermediate VA at every visit and greater VA in the intermediate range of defocus curve (at -1.50 and - 2.00 D) than the eyes with bifocal TIOLs. The postoperative RA of the eyes with trifocal IOL and FSAK was significantly higher than that of the bifocal TIOL-implanted eyes at the 3- and 6-month follow-ups. Discussion: Both FSAK and TIOL implantation effectively reduce pre-existing moderate astigmatism in patients with cataract. The eyes with bifocal TIOLs had more stable long-term astigmatism correction, whereas those with trifocal IOLs and FSAK had better intermediate VA. Therefore, a mix-and-match implantation of trifocal IOL with FSAK and contralateral bifocal TIOL could achieve effective astigmatism correction and provide an overall optimal VA.

Comparison of visual outcomes in adult patients with different types of developmental cataracts after toric multifocal intraocular lenses implantation.

PURPOSE:  To analyze and compare the visual performance and patient satisfaction following the implantation of toric multifocal intraocular lenses (TMIOLs) in adult patients with different types of developmental cataracts (DC) accompanied by corneal astigmatism (CA). METHODS:  This is a prospective observational cohort study. Patients diagnosed with DC aged 18-30 years were divided into three groups according to the anatomic location of the lens opacity: cortical, nuclear, and posterior subcapsular (PSC) groups, and implanted with TMIOLs. Visual acuity (VA), postoperative refractive astigmatism (RA), intraocular lens (IOL) rotation, high-order aberrations (HOAs), modulation transfer function (MTF) curve, and Strehl ratio were compared. The functional vision and incidence of photic phenomena were surveyed using questionnaires. RESULTS:  Fifty-five eyes of 37 patients were enrolled and completed a 1-year follow-up. The mean CA was 2.06 ± 0.79 D preoperatively, and the mean RA was 0.29 ± 0.30 D 3-month postoperatively. The IOL rotation was 2.48° ± 1.89°, with no deviation > 10°. At 12 months, mean uncorrected distance VA improved from 0.93 ± 0.41 preoperatively to 0.08 ± 0.08 logarithm of the minimum angle of resolution (logMAR), mean uncorrected near VA increased from 0.45 ± 0.30 preoperatively to 0.12 ± 0.11 logMAR, and mean uncorrected intermediate VA was 0.14 ± 0.08 logMAR. The cortical and nuclear groups displayed better improvements in uncorrected near and intermediate VA than that in the PSC group. Similar results were observed in the 3-month defocus curves, HOAs, MTF curve, halo incidence, and near vision satisfaction. CONCLUSION: In adult patients with DC accompanied by CA, TMIOLs implantation achieved good postoperative visual outcomes and significantly reduced glasses dependency. Patients with cortical or nuclear lens opacity showed better whole-course VA and quality of vision, while patients with PSC opacity showed unsatisfactory near vision and suffered more photic phenomena.

Binocular Visual Outcomes Comparison of Two Trifocal Intraocular Lenses in High-Myopic Cataract Patients: A 1-Year Multicenter Study.

PURPOSE: To compare the postoperative visual outcomes and quality of vision obtained with 2 types of diffractive trifocal intraocular lenses (IOLs) in patients with highly myopic cataracts. DESIGN: Prospective, multicenter, randomized controlled trial. METHODS: Patients with high-myopic cataracts were randomized to binocular implantation of either the TFNT00 (n = 27) or the 839 MP (n = 28) trifocal IOLs at 3 surgery centers in China and were followed up for 1 year. Postoperative uncorrected distance, uncorrected intermediate, and uncorrected near visual acuity, and best-corrected distance visual acuity were measured. The defocus curve, high-order aberrations, modulation transfer function curve, Strehl ratio, and reading ability were compared between both groups. The functional vision and incidence of photic phenomena were surveyed using questionnaires. RESULTS: Visual acuity at all ranges of vision was significantly improved in both groups. The TFNT00 group showed superior uncorrected intermediate visual acuity to that in the 839 MP group (P = .013). Reading ability at 40 and 60 cm was similar in both groups (P ≥ .05), whereas the preferred reading distances for near and intermediate were significantly different. The TFNT00 group had a significantly higher mean Visual Function Index 14 score, lower incidence of photic phenomena, and less posterior capsular opacity than the 839 MP group. CONCLUSION: Bilateral implantation of both types of trifocal IOLs in patients with high-myopic cataracts provided good whole-course visual restoration, although recognition of fine Chinese characters remained impeded. As compared with 839 MP IOL, TFNT00 IOL resulted in greater patient satisfaction in intermediate activities, with a lower photic phenomena incidence.

Extracellular vesicles secreted from mesenchymal stem cells exert anti-apoptotic and anti-inflammatory effects via transmitting microRNA-18b in rats with diabetic retinopathy.

Diabetic retinopathy (DR) is a major cause of visual deficits and blindness in the working-age population and inflammatory response is a key event during DR. In this study, we investigated the anti-inflammatory properties of small extracellular vesicles (sEVs) derived from human umbilical cord mesenchymal stem cells (hUCMSCs) in a diabetic rat model and human retinal microvascular endothelial cells. After development of DR in rats subjected to diabetes induction with streptozotocin (STZ), the DR rats were treated with different concentrations of hUCMSC-sEVs. Our results showed that the treatment of the retinas of DR rats with hUCMSC-sEVs not only reduced the level of vascular leakage in the retinas of rats but also decreased the retinal thickness as well as the associated inflammation. Further, our in vitro evidences suggest that hUCMSC-sEVs repress high glucose (HG)-induced cell inflammation and apoptosis. Subsequently, we analyzed the differentially expressed microRNAs (miRNAs) in the hUCMSC-sEVs by microarray and performed in silico studies to predict the target mRNA of miR-18b. Our findings also revealed that the expression of miR-18b was significantly elevated in the retina of diabetic rats after sEV treatment. In addition, miR-18b was found to target mitogen-activated protein kinase kinase kinase 1 (MAP3K1), thereby inhibiting NF-κB p65 phosphorylation to alleviate DR. Overall, this study highlights the potential of hUCMSCs-sEVs as biomaterials for anti-inflammatory and anti-apoptotic effects in DR by transferring miR-18b.

An Optical Coherence Tomography-Based Deep Learning Algorithm for Visual Acuity Prediction of Highly Myopic Eyes After Cataract Surgery.

BACKGROUND: Due to complicated and variable fundus status of highly myopic eyes, their visual benefit from cataract surgery remains hard to be determined preoperatively. We therefore aimed to develop an optical coherence tomography (OCT)-based deep learning algorithms to predict the postoperative visual acuity of highly myopic eyes after cataract surgery. MATERIALS AND METHODS: The internal dataset consisted of 1,415 highly myopic eyes having cataract surgeries in our hospital. Another external dataset consisted of 161 highly myopic eyes from Heping Eye Hospital. Preoperative macular OCT images were set as the only feature. The best corrected visual acuity (BCVA) at 4 weeks after surgery was set as the ground truth. Five different deep learning algorithms, namely ResNet-18, ResNet-34, ResNet-50, ResNet-101, and Inception-v3, were used to develop the model aiming at predicting the postoperative BCVA, and an ensemble learning was further developed. The model was further evaluated in the internal and external test datasets. RESULTS: The ensemble learning showed the lowest mean absolute error (MAE) of 0.1566 logMAR and the lowest root mean square error (RMSE) of 0.2433 logMAR in the validation dataset. Promising outcomes in the internal and external test datasets were revealed with MAEs of 0.1524 and 0.1602 logMAR and RMSEs of 0.2612 and 0.2020 logMAR, respectively. Considerable sensitivity and precision were achieved in the BCVA < 0.30 logMAR group, with 90.32 and 75.34% in the internal test dataset and 81.75 and 89.60% in the external test dataset, respectively. The percentages of the prediction errors within ± 0.30 logMAR were 89.01% in the internal and 88.82% in the external test dataset. CONCLUSION: Promising prediction outcomes of postoperative BCVA were achieved by the novel OCT-trained deep learning model, which will be helpful for the surgical planning of highly myopic cataract patients.

Prevalence and risk factors for diabetic retinopathy in a cross-sectional population-based study from rural southern China: Dongguan Eye Study.

RESEARCH QUESTION: The current population-based study aimed to investigate the prevalence of diabetic retinopathy (DR) and risk factors among residents over 40 years old in the rural area of Dongguan, southern China. STUDY DESIGN: The Dongguan Eye Study was a population-based study from September 2011 to February 2012. SETTING: The area was set in the rural area of Dongguan, southern China. PARTICIPANTS: Adult rural population aged 40 or older. INTERVENTION: Participants underwent haematological, physical, ophthalmic examinations and completed a questionnaire regarding lifestyles and systemic medical conditions. PRIMARY AND SECONDARY OUTCOME MEASURES: The frequency and risk factors of visual impairment and the major vision-threatening eye diseases. RESULTS: Of the 8952 Han Chinese, 1500 were diagnosed with type 2 diabetes mellitus (T2DM) with an average age of 59.5±11.1 years, and 1310 participants with fundus photography results were analysed. Standardised prevalence rate of DR was 18.2% for all patients with diabetes, 32.8% for the patients with previously diagnosed diabetes and 12.6% for newly diagnosed patients with T2DM. The prevalence rate of male DR was significantly higher than that of female DR (23.0% vs 14.1%, p<0.001). No significant difference was found in age-specific prevalence of DR. In diabetic patients, the prevalence rates of vision-threatening diabetic retinopathy, diabetic macular oedema and clinically significant macular oedema were 2.5%, 2.8% and 0.9%, respectively. Male gender, higher education level, longer duration of diabetes mellitus (DM), higher systolic blood pressure and glycosylated haemoglobin were independent risk factors for DR development in patients with diabetes. CONCLUSION: A relatively lower prevalence of DR was found among the participants with T2DM in residents over 40 years in the rural area of southern China. Thus, an ophthalmic examination is recommended, especially for individuals with DM and DR risk factors. There is a need to increase awareness and education on DM and DR, especially in subjects with DR risk factors to reduce the incidence of DR and macular oedema.

Myopic Laser Corneal Refractive Surgery Reduces Interdevice Agreement in the Measurement of Anterior Corneal Curvature.

OBJECTIVES: To investigate interdevice differences and agreement in the measurement of anterior corneal curvature obtained by different technologies after laser corneal refractive surgery. METHODS: The prospective study comprised 109 eyes of 109 consecutive patients who had undergone laser-assisted in situ keratomileusis (LASIK). Preoperative and postoperative corneal parameters were measured by Scheimpflug imaging (Pentacam), Placido-slit-scanning (Orbscan) and auto-keratometry (IOLMaster). Preoperative and postoperative anterior corneal curvatures (K readings) were compared between devices. Interdevice agreement was evaluated by Bland-Altman analysis. RESULTS: Preoperatively, the difference of K reading for Pentacam-IOLMaster (0.04±0.20 D) was not statistically significant (P=0.059). The differences between Pentacam-Orbscan and Orbscan-IOLMaster were 0.20±0.34 D (P<0.001) and -0.17±0.29 D (P<0.001), respectively. After surgery, no difference was found for Pentacam-Orbscan (-0.05±0.38, P=0.136). The differences between Pentacam-IOLMaster and Orbscan-IOLMaster were 0.13±0.29 D (P<0.001) and 0.19±0.34 D (P<0.001). Preoperative interdevice agreement (95% limit of agreement [LOA]) between Pentacam and Orbscan, Pentacam and IOLMaster, and Orbscan and IOLMaster were 1.31 D, 0.79 D and 1.14 D, respectively. The 95% LOAs decreased to 1.47 D, 1.14 D, and 1.34 D after refractive surgery. CONCLUSION: Corneal refractive surgery changed the preoperative and postoperative interdevice differences in corneal curvature measurements and reduced interdevice agreement, indicating that the devices are not interchangeable.

Eaf2 protects human lens epithelial cells against oxidative stress­induced apoptosis by Wnt signaling.

The tumor suppressor protein ELL-associated factor 2 (Eaf2) serves an important role in lens development and maturation; however, its role in oxidative stress­induced cataract formation remains unclear. In the present study, an in vitro apoptosis model was constructed by treating HLE­B3 cells with 50 µM hydrogen peroxide (H2O2), and was confirmed by flow cytometry. Subsequently, overexpression of Eaf2 was induced in H2O2­induced HLE­B3 cells by ligating Eaf2 cDNA to a pcDNA3.0 plasmid and the role of Wnt3a in the function of Eaf2 was also assessed by inhibiting the expression of the gene in Eaf2­overexpression cells. The expression levels of glycogen synthase kinase 3ß, ß­catenin, Eaf2, caspase 3, Wnt3a, B­cell lymphoma 2 (Bcl­2) and Bcl­2­associated X protein were examined using reverse transcription­quantitative polymerase chain reaction and western blot analysis. Immunocytochemistry was used to locate Eaf2 and Wnt3 protein expression in the H2O2­induced HLE­B3 cells. The results indicated that Eaf2 was able to effectively suppress H2O2­induced apoptosis of HLE cells via inhibition of caspase 3 production and activation of Wnt3a signaling. In addition, knockdown of Wnt3a in Eaf2­overexpression cells evidently counteracted the effect of Eaf2 in antagonizing H2O2­induced apoptosis. Taken together, these findings suggested that Eaf2 may suppress oxidative stress­induced apoptosis of HLE­B3 cells exerted through the activation of Wnt3a signaling.

Prevalence and causes of low vision and blindness in a Chinese population with type 2 diabetes: the Dongguan Eye Study.

To assess the prevalence and causes of low vision and blindness in type 2 diabetes patients, a population-based cross-sectional study including 8952 rural-dwelling residents aged 40 years or older from Hengli Town in Southern China was conducted. Participants underwent standard interviews, physical measurements, laboratory tests, and comprehensive eye examinations. Low vision and blindness were defined based on WHO criteria. Visual acuity data were available for 1348 (89.9%) of the 1500 subjects with type 2 diabetes. Age-standardized prevalence of bilateral low vision and blindness assessed in the better-seeing eye was 2.9% (95% confidence interval [CI]: 2.0-3.8) and 0.7% (95% CI: 0.2-1.1) based on best-corrected visual acuity (BCVA). Cataracts were the primary cause of low vision and blindness. Visual impairment was associated with age (odds ratio [OR]: 3.73, 95% CI: 2.39-5.83), education level (OR: 3.21, 95% CI: 1.63-6.29), duration of diabetes (OR: 1.14, 95% CI: 1.04-1.25) and body mass index (OR: 0.86, 95% CI: 0.77-0.95). Our data suggest that approximately 70% of visual impairment in this diabetic population could be eliminated with appropriate cataract surgery or spectacle correction. Greater consideration should be given to older type 2 diabetes patients with a level of lower education.

MicroRNA-34a promoting apoptosis of human lens epithelial cells through down-regulation of B-cell lymphoma-2 and silent information regulator.

AIM: To investigate the role of microRNA-34a (miR-34a) in the induction of apoptosis of human lens epithelial (HLE-B3) cells. METHODS: The apoptosis of HLE-B3 cells was detected by Annexin V-PE apoptosis detection kit after the treatment with 200 µmol/L H2O2 for 24h and lentiviral miR-34a vector transfection. The expression of miR-34a in the cells was quantified by quantitative real time polymerase chain reaction (qRT-PCR) in response to H2O2 exposure and the vector transfection. The effects of overexpression of miR-34a on the expression of B-cell lymphoma-2 (Bcl-2) and silent information regulator 1 (SIRT1) was determined by qRT-PCR and Western blot. RESULTS: The expression of miR-34a was up-regulated by the treatment of H2O2 in HLE-B3 cells. The increased expression of miR-34a is accompanied with the cell apoptosis. Consistence with the H2O2 exposure, ectopic overexpression of miR-34a in HLE-B3 cells promoted cells apoptosis. Importantly the anti-apoptosis factors Bcl-2 and SIRT1 were reduced significantly by up-regulation of miR-34a in HLE-B3 cells. CONCLUSION: MiR-34a promotes the apoptosis of HLE-B3 cells by down-regulating Bcl-2 and SIRT1, suggesting that miR-34a may involve in the pathogenesis of cataract formation and targeting miR-34a may be a potentially therapeutic approach for treatment of cataract.

Femtosecond laser capsulotomy versus manual capsulotomy: a Meta-analysis.

AIM: To perform a Meta-analysis on the precision and safety of femtosecond laser (FSL) capsulotomy compared with manual continuous curvilinear capsulotomy (CCC). METHODS: We searched PubMed, EMBASE, Web of Science, the Cochrane Library databases, and Clinical Trials.gov that maintained our inclusion criteria. Reference lists of retrieved articles were also reviewed. The effects of morphology of capsulorhexis and the tears of anterior capsule were calculated by using random-effect models. RESULTS: We identified 4 randomized and 7 nonrandomized studies involving 2941 eyes. The diameter of capsulotomy and the rates of anterior capsule tear showed no statistically difference between FSL group and manual group (MD=0.03; 95%CI, -0.03 to 0.09, P=0.31), and (OR=1.40; 95%CI, 0.28 to 6.97, P=0.68) respectively. In terms of the circularity of capsulotomy, FSL group had a more significant advantage than the manual CCC group (MD=0.09; 95%CI, 0.05 to 0.12, P<0.0001). CONCLUSION: Our Meta-analysis shows that FSL can perform a capsulotomy with more precision and higher reliability than manual CCC. The results in diameter of capsulotomy and the rate of anterior capsule tears was no significant difference between FSL and manual CCC groups. However in terms of circularity, the FSL was superior to the manual procedure.

[Annular electrode lacrimal duct reconstruction for improving the safety and efficacy of lacrimal stent implantation: a randomized clinical trial].

OBJECTIVE: To evaluate the effect of annular electrode lacrimal duct reconstruction in improving the safety and efficacy of nasolacrimal duct stent implantation for treatment of nasolacrimal duct obstruction. METHODS: This randomized clinical trial was performed to compare the efficacy, success rate of intubation, time used for stent implantation, intraoperative pain, and extubation-assciated complications between nasolacrimal stent implantation with and without annular electrode lacrimal duct reconstruction. RESULTS: A total of 119 eligible patients were enrolled in this trial. The total curative rate at 6 months of follow up after extubation was 70.9% (83/117) in these patients, and was significnatly higher in pateinets with lacrimal duct reconstruction than in those without [80.6% (54/67) vs 58.0% (29/50); χ(2)=7.093, P<0.05]. The total success rate of stent implantation was 98.3% (117/119) in all the patients initially enrolled, and two patients experienced failure of stent implantation and were excluded; the success rate was signfiicantly higher in patients initially enrolled in the lacrimal duct reconstruction group (χ(2)=6.282, P<0.05). The median time required for intubation was shorter in lacrimal duct reconstruction group (12 s vs 33 s; Z=-36.722, P<0.05). The intendity of intraoperative pain was comparable between the two groups (t=0.833, P=0.405). The total rate of puncta injury was 43.6% (51/117) in these patients and similar between the two groups (χ(2)=1.459, P=0.227). The total rate of extubation difficulty was 9.4% (11/117) in all the patients, and was lower in lacrimal duct reconstruction group [4.5% (3/67) vs 16% (8/50); χ(2)=4.463, P<0.05]. Stent breakage in extubation occurred in 4.3% (11/117) of the patients with similar rates between the two groups (χ(2)=2.964, P=0.085). Spearman bivariate correlation analysis showed that the time required for intubation was inversely correlated with the treatment efficacy (r=-0.584, P<0.05) and positively with the occurrence of extubation difficulty (r=0.491, P<0.05); extubation difficulty was inversely correlated with the curative effect (r=-0.511, P<0.05). CONCLUSION: Annular electrode nasolacrimal duct reconstruction can increase the safety and efficacy of nasolacrimal duct stent implantation for treatment of nasolacrimal duct obstruction.

TGF-ß2 induces epithelial-mesenchymal transition in cultured human lens epithelial cells through activation of the PI3K/Akt/mTOR signaling pathway.

The present study aimed to investigate whether the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signaling pathway is involved in the transforming growth factor ß2 (TGF-ß2)-induced epithelial-mesenchymal transition (EMT) in human lens epithelial (HLE) cells. HLEB-3 cells were cultured and stimulated with 10 ng/ml TGF-ß2 for 24 h. Western blotting was then performed to analyze the expression levels of connexin 43 and fibronectin, and the activities of Akt and mTOR. Confocal cell immunofluorescence was used to observe the expression of phosphorylated (p)-Akt. The toxicity of 2-(4-morpholinyl)-8-phenyl-4H-1-benzopyran-4-one (LY294002) was assessed using a Cell Counting Kit-8 assay, and inhibition investigations were performed using a PI3K inhibitor. The expression of connexin 43 was suppressed and the expression of fibronectin was increased when the cells were stimulated with 10 ng/ml TGF-ß2 for 24 h. In addition, Akt and mTOR were activated during TGF-ß2-induced EMT. Treatment of with LY294002 (20 µM) inhibited the activation of Akt and mTOR and effectively prevented TGF-ß2-induced EMT in the HLECs. Therefore, the results of the present study indicated that TGF-ß2 induces EMT by activating the PI3K/Akt/mTOR signaling pathway in cultured HLECs.

Biometry and corneal astigmatism in cataract surgery candidates from Southern China.

PURPOSE: To analyze biometry data and corneal astigmatism in cataract candidates from Southern China. SETTING: Guangdong Eye Institute, Guangdong General Hospital, Guangzhou, China. DESIGN: Cross-sectional hospital-based study. METHODS: The axial length (AL), anterior chamber depth (ACD), horizontal corneal diameter (white to white [WTW]), and corneal power (keratometry [K], flat K, steep K) were measured using the IOLMaster system. Ocular biometric data were collected and analyzed between 2007 and 2011. RESULTS: The study comprised 6750 eyes of 4561 consecutive cataract candidates with a mean age of 70.4 years ± 10.5 (SD). The mean AL, ACD, and WTW were 24.07 ± 2.14 mm, 3.01 ± 0.57 mm, and 11.68 ± 0.45 mm, respectively. All values were statistically significantly greater in men than in women (P < .001) and had a significant trend toward a decrease as age increased (P < .001). The mean K value was 44.13 ± 1.63 D. The median corneal astigmatism was 0.90 D (interquartile range, 0.54-1.43). Corneal astigmatism of 1.00 D or greater was found in 2963 eyes (43.9%), and 3590 eyes (53.2%) had against-the-rule (ATR) astigmatism. The axis of corneal astigmatism turned in the ATR direction with age. CONCLUSIONS: This study provides reference data for cataract patients from Southern China. The profiles of ocular biometric data and corneal astigmatism can help improve surgical procedures and intraocular lens design for the Chinese population. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

mTOR regulates TGF-ß2-induced epithelial-mesenchymal transition in cultured human lens epithelial cells.

BACKGROUND: Post-cataract surgery fibrosis in the lens capsule is caused by epithelial to mesenchymal transition (EMT) of the lens epithelium. Mammalian target of rapamycin (mTOR) has been demonstrated to be a key regulator of EMT. The aim of this study was to investigate the role of mTOR in transforming growth factor ß2 (TGF-ß2)-induced EMT in human lens epithelial cells (HLECs). METHODS: Human lens epithelial B-3 (HLEB-3) cells were cultured with 10 ng/ml TGF-ß2 for different periods of time. The expression of E-cadherin, connexin 43, fibronectin and α-smooth muscle actin (α-SMA), and activation of mTOR were determined by Western blots. Cell migration was assessed by wound healing assay. An inhibition test was performed using two kinds of mTOR inhibitors. RESULTS: E-cadherin and connexin 43 expressions were suppressed, whereas fibronectin and α-SMA expressions were increased in HLEB-3 cells after treatment with TGF-ß2. mTOR was activated during the TGF-ß2-induced EMT in a time-dependent manner. Rapamycin or Ku-0063794 with 100 nM was able to inhibit the phosphorylation of mTOR and impaired EMT induced by TGF-ß2. Cell motility enhanced by TGF-ß2 for 24 h was attenuated by both rapamycin and Ku-0063794. CONCLUSIONS: mTOR is activated during TGF-ß2-induced EMT in HLECs, suggesting that it is involved in the regulation of TGF-ß2-induced EMT and may contribute to the development of posterior capsule opacification.

Corneal power estimation for intraocular lens power calculation after corneal laser refractive surgery in Chinese eyes.

PURPOSE: To develop and evaluate an algorithm for corneal power estimation in intraocular lens (IOL) power calculation after corneal laser refractive surgery in Chinese eyes. SETTING: Guangdong Eye Institute, Guangdong Academy of Medical Sciences, Guangzhou, China. DESIGN: Prospective comparative case series. METHODS: Corneal parameters in Chinese eyes and German eyes were measured using a rotating Scheimpflug camera. Corneal power was simplified as a corrective algorithm: K(C) = 1.114 × K(M) + K(2) (K(M) = measured K reading; K(2) = K(P) - K(A) × K(P) × CT/1.376; K(A) = anterior corneal power; K(P) = posterior corneal power; CCT = central corneal thickness). The variation and change in K(2) induced by refractive surgery were analyzed in Chinese eyes. The corrective algorithm was identified as K(C) = 1.114 × K(M) - 6.20. The method was evaluated in Chinese cataract cases after refractive surgery using the Haigis formula. RESULTS: No difference in anterior corneal radius (R(A)) or CCT between Chinese eyes and German eyes were found; however, the posterior corneal radius (R(P)), R(A)/R(P) ratio, keratometric index, and K(2) were different. The mean K(2) was -6.23 diopters (D) ± 0.24 (SD) in Chinese eyes and -6.12 ± 0.23 D in German eyes (P<.01). The mean change in K(2) induced by refractive surgery was -0.02 ± 0.06 D. The median absolute prediction error in IOL power calculation was 0.43 D (range 0.01 to 1.80 D). CONCLUSION: The algorithm was a relatively reliable method in IOL power calculation after corneal refractive surgery in Chinese eyes.

[Clincal outcome in conversion from small incision sutureless to phacoemulsification cataract surgery].

PURPOSE: To investigate the clinical outcome during the conversion from small incision sutureless cataract surgery (SICS) to phacoemulsfication cataract surgery (Phaco). METHODS: During the conversion period from SICS to phaco, 241 cataract cases were assigned to SICS and phaco surgery procedures. The intraoperative complications and early postoperative outcome were assessed. RESULTS: The 1st day visual acuity outcome (VA 0.5 or better) was lower in phaco grouop (p<0.05), however, the visual acuity outcomes were no longer statistically different at 1 week and 1 month visits (p>0.05 for each visit). Among 193 cases operations in phaco group, 51 cases (26.4%) developed corneal edema at 1 day visit, 13 cases(6.7%) had posterior capsular rapture, 5 cases(2.6%) had zonular rupture, 5 cases (2.6%) failed to implant IOL. These rates were higher than what were found in SICS group. CONCLUSIONS: The outcome of phaco cataract surgery is comparable with SICS during this conversion period. Techniques that the surgeons may pay attention to are also discussed.

Impact of axis misalignment of toric intraocular lenses on refractive outcomes after cataract surgery.

PURPOSE: To theoretically and clinically evaluate the impact of axis misalignment of toric intraocular lenses (IOLs) on postoperative refraction. SETTING: International Vision Correction Research Center, University of Heidelberg, Heidelberg, Germany. DESIGN: Case series. METHODS: A method based on mathematical solutions to obliquely crossed spherocylinders was derived according to the pseudophakic refractive properties and used to analyze the impact of toric IOL misalignment on postoperative refraction. The refractive outcomes were theoretically analyzed and actual postoperative outcomes assessed to confirm the theoretically identified impact. RESULTS: The mean IOL misalignment was 12.5 degrees ± 6.7 (SD). Three main factors had an impact on refractive outcomes: hyperopic change in refractive sphere, reduction in astigmatic correction, and rotation of the astigmatic axis. The mean calculated spherical change was 0.32 ± 0.23 diopters (D) and the actual change, 0.36 ± 0.71 D. The mean calculated reduction in astigmatic correction was 0.65 ± 0.45 D and the actual reduction, 0.95 ± 0.54 D, indicating undercorrection of preexisting astigmatism. The mean calculated absolute astigmatic rotation was 32.7 ± 13.2 degrees (range 8 to 55 degrees) and the actual rotation, 29.1 ± 17.4 degrees. There was a correlation between the calculated and actual reduction (r(2) = 0.51; P = .001) and between the calculated and actual rotation (r(2) = 0.86; P<.001). CONCLUSION: In addition to a reduction in astigmatic correction, misalignment of toric IOLs induced hyperopic spherical change and astigmatic rotation.

[Analysis of corneal asphericity in patients after phacoemulsification].

OBJECTIVE: To investigate the distribution of corneal Q-value in the age-related cataract patients and aspherical features of cornea before and after the phacoemulsification (PHACO). METHODS: Thirty-nine eyes of 30 age-related cataract patients in our department were included. Transparent cornea incision at the temporal cornea was applied for patients with cornea astigmatism < 1.00 D and transparent cornea incision at the maximum curvature meridian for patients with cornea astigmatism > or = 1.00 D in PHACO. All patients were followed up to 3 months, corneal Q-value, corneal curvature, astigmatism were examined before and after PHACO, distribution of corneal Q-value and their correlation factors were analyzed. RESULTS: The mean corneal Q-value before and after the PHACO was -0.07 +/- 0.22 and -0.11 +/- 0.16, respectively. There was no statistical difference between the corneal Q-values before and after surgery (t = 1.14, P = 0.26). The mean of corneal curvature before and after the PHACO was (44.6 +/- 1.92) D and (44.70 +/- 1.47) D, respectively. There was no statistical difference between corneal curvature before and after the operation (t = -0.69, P = 0.50). The corneal Q-value was negatively co-related with corneal curvature before the surgery (r = -0.46, P = 0.003). The mean astigmatism power before and after the HACO was (0.67 +/- 0.43) D and (0.66 +/- 0.42) D, respectively. There was no statistical difference between astigmatism power before and after the surgery (t = -0.24, P = 0.82). There was no relationship between the corneal Q-value and astigmatism power before surgery (r = -0.24, P = 0.14). CONCLUSIONS: The corneal Q-value of aged patients is in normal distribution, is negative in the majority, and showed a negative relationship with corneal curvature. There is no statistical difference between the corneal Q-value, corneal curvature, and astigmatism power before and after PHACO surgery.