Citrus fruit intake and the risk of nasopharyngeal carcinoma.

BACKGROUND AND OBJECTIVES: Citrus fruit are suggested to be associated with reduced risk of nasopharyngeal carcinoma (NPC), but findings from epidemiologic studies have been inconsistent. We aimed to synthesize the association by conducting a meta-analysis of existing evidence. METHODS AND STUDY DESIGN: Databases including Medline, EMBASE, Web of science, and the Cochrane Library were searched for eligible studies up to March 2019 using a series comprehensive searching terms. The adjusted odds ratios (ORs) of citrus fruit intake with NPC risk from each study were extracted to calculate a pooled association estimate with its 95% confidence interval (CI). RESULTS: Nine studies totaling 3304 cases and 3850 controls were included in this analysis. Citrus fruit intake was significantly associated with reduced risk of NPC (OR: 0.72, 95% CI 0.58-0.91, p=0.005). In addition, this association tended to be stronger in Chinese (OR: 0.67, 95% CI 0.54-0.84, p<0.001). Dose-response analysis using cubic splines showed the risk of NPC decreased by 21% for citrus fruit intake of 4 times/week (OR: 0.79, 95% CI 0.66-0.94). CONCLUSIONS: Consumption of citrus fruit was associated with a significantly reduced risk of NPC, especially in Chinese.

[Clinical research of anterior chamber inflammation after phacoemulsification surgery in patients with complicated cataract secondary to uveitis].

OBJECTIVE: To investigate anterior chamber inflammation after phacoemulsification with intraocular lens (IOL) implantation in patients with Vogt-Koyanagi-Harada (VKH) syndrome or Behçet's disease (BD). METHODS: Cohort study. Seventeen patients (20 eyes) with complicated cataracts and VKH syndrome or BD who underwent phacoemulsification with IOL implantation at Zhongshan Ophthalmic Center, Sun Yat-Sen University (SYSU) between January 2010 and June 2011 were included as the experimental group in this study. Cataract surgery was performed on these patients only when uveitis had been under control for more than three months. Thirty patients (40 eyes) with age-related cataracts who underwent phacoemulsification with IOL implantation in the same period were included as the control group. Quantitative measurements of anterior chamber aqueous flare and inflammatory cells were conducted preoperatively and postoperatively using a Laser Flare Cell Meter (LFCM). Independent t-test was used to compare patients' ages, and the energy and time of phacoemulsification between the two groups. The Student's t-test was used to assess the differences between paired data preoperatively and postoperatively. Independent t-test was also used to assess the quantitative data between groups. RESULTS: The study recruited 20 eyes in the experimental group and 40 eyes in the control group, including 11 eyes from 9 VKH patients and 9 eyes from 8 BD patients. The preoperative and postoperative flare values in the experimental group were (19.86 ± 6.47), (44.28 ± 18.47), (35.60 ± 12.65), (23.85 ± 8.41), and (13.86 ± 4.27) pc/ms, respectively, which were statistically higher than that of the control group preoperatively, and on days 1, 7, 30, and 90 after surgery (tpre = 4.643, Ppre < 0.01; t1 = 6.035, P1 < 0.01; t7 = 3.595, P7 = 0.001; t30 = 4.658, P30 < 0.01; t90 = 3.308, P90 = 0.002). Aqueous flare in Group A and Group B declined to preoperative levels on day 30 (t = 0.320, P = 0.753) and day 7 (t = 0.454, P = 0.653). For the experimental group, the inflammatory cell count on day 1 and 7 was (83.46 ± 27.08) and (27.56 ± 8.32) cells/0.5 mm(3), respectively, which was significantly higher than the preoperative level [(6.47 ± 3.56)cells/ 0.5 mm(3), t1 = 5.261, P1 < 0.01; t7 = 2.766, P7 = 0.012]. On days 30 and 90, the inflammatory cell count was (11.43 ± 4.81) and (4.82 ± 2.29) cells/0.5 mm(3), respectively, and there was no statistically significant difference in the inflammatory cell count compared with the preoperative level (t30 = 2.348, P30 = 0.042; t90 = 1.376, P90 = 0.186). For the control group, inflammatory cell count reduced to pre-operative level on day 7 (t7 = 2.464, P7 = 0.018). CONCLUSIONS: Anterior chamber inflammation reaches peak levels one week postoperatively in VKH and BD patients who receive phacoemulsification with IOL implantation. It takes three months for the inflammation to recede, and might take longer for complete restoration of the blood-aqueous barrier.

Efficacy of wet-lab training versus surgical-simulator training on performance of ophthalmology residents during chopping in cataract surgery.

AIM: To analyze whether wet-lab training (WLT) or surgical-simulator training (SST) is better for ophthalmology residents to master the chopping technique. METHODS: Sixty ophthalmology residents (in their second year) and three cataract surgeons participated in the study. The residents were randomly separated into two groups, WLT group and SST group. The residents in WLT group were asked to perform 10 trials of chopping using pig eyes and scored by the surgeons, and then they performed and scored using simulator for one time. The residents in SST group underwent 10 trials of chopping using simulator, and the simulator scored each trail. Then, this group were asked to perform the chopping using pig eyes and scored by the surgeons. At last, we investigated the residents' satisfaction about the training. RESULTS: The demographic characteristics had no significant differences between the two groups. Recorded by the simulator, the residents in SST group got significantly higher overall score (83.90±1.31) than WLT group (78.73±1.92, P=0.03). And the residents in SST group got less corner area injured, and they spend less time than WLT group (P<0.05). Moreover, the residents in WLT group used more ultrasonic energy value than SST group (P=0.03). However, scored by the surgeons, the residents in two groups got nearly the same overall score. The residents in WLT group performed better on the frequencies of posterior capsule torn and incisional stress (P=0.03, 0.008, respectively). In the survey, the residents in two groups held the same opinion that the training was helpful and they strongly recommended this training. And all of them enjoyed the training, and enjoyed being randomized in their own group. However, with respect to the realistic character, the residents thought that WLT was better than SST (P<0.001). CONCLUSION: Both of the Eyesi surgical-stimulator and the wet-lab improve the residents' chopping ability and each has its own advantages. The combination of the two training ways could be considered to be a part of the training curriculum for new residents.

Physical activity and risk of age-related cataract.

AIM: To summarize quantitatively the prospective association between physical activity and age-related cataract (ARC) risk. METHODS: PubMed, Embase, Web of Science, and Cochrane Library were systematically searched for all relevant follow up studies until July 2019. Multivariable-adjusted relative risks (RRs) and corresponding 95% confidence intervals (CIs) from individual studies were used to calculate the overall summary estimates. The dose-response relationship was assessed using generalized least-squares trend estimation. RESULTS: Six prospective cohort studies, involving 19 173 cases in 6.2-12.1y follow up of 171 620 participants, were included in the analysis. Increased physical activity was significantly associated with reduced risk of ARC by 10% (RR: 0.90; 95%CI: 0.81, 0.99, P=0.04). Stratified analysis by assessment method for physical activity suggest that studies using metabolic equivalent (MET) per day tended to report a slightly stronger association with ARC (RR: 0.85; 95%CI: 0.81, 0.90, P<0.001) than studies which assessed activity by weekly activity (RR: 0.96; 95%CI: 0.89, 1.03, P=0.24). Dose-response analysis indicated that the risk of ARC decreased by 2% (RR: 0.98; 95%CI: 0.98, 0.99, P<0.001) for every 6 METs per day increase in activity. CONCLUSION: The findings from this Meta-analysis provide additional evidence that increased physical activity is inversely associated with ARC risk dose-responsively.

Dietary vitamin and carotenoid intake and risk of age-related cataract.

Background: Existing studies suggest that dietary vitamins and carotenoids might be associated with a reduced risk of age-related cataract (ARC), although a quantitative summary of these associations is lacking. Objectives: The aim of this study was to conduct a meta-analysis of randomized controlled trials (RCTs) and cohort studies of dietary vitamin and carotenoid intake and ARC risk. Methods: The MEDLINE, EMBASE, ISI Web of Science, and Cochrane Library databases were searched from inception to June 2018. The adjusted RRs and corresponding 95% CIs for the associations of interest in each study were extracted to calculate pooled estimates. Dose-response relations were assessed with the use of generalized least-squares trend estimation. Results: We included 8 RCTs and 12 cohort studies in the meta-analysis. Most vitamins and carotenoids were significantly associated with reduced risk of ARC in the cohort studies, including vitamin A (RR: 0.81; 95% CI: 0.71, 0.92; P = 0.001), vitamin C (RR: 0.80; 95% CI: 0.72, 0.88; P < 0.001), vitamin E (RR: 0.90; 95% CI: 0.80, 1.00; P = 0.049), ß-carotene (RR: 0.90; 95% CI: 0.83, 0.99; P = 0.023), and lutein or zeaxanthin (RR: 0.81; 95% CI: 0.75, 0.89; P < 0.001). In RCTs, vitamin E (RR: 0.97; 95% CI: 0.91, 1.03; P = 0.262) or ß-carotene (RR: 0.99; 95% CI: 0.92, 1.07; P = 0.820) intervention did not reduce the risk of ARC significantly compared with the placebo group. Further dose-response analysis indicated that in cohort studies the risk of ARC significantly decreased by 26% for every 10-mg/d increase in lutein or zeaxanthin intake (RR: 0.74; 95% CI: 0.67, 0.80; P < 0.001), by 18% for each 500-mg/d increase in vitamin C intake (RR: 0.82; 95% CI: 0.74, 0.91; P < 0.001), by 8% for each 5-mg/d increase in ß-carotene intake (RR: 0.92; 95% CI: 0.88, 0.96; P < 0.001), and by 6% for every 5 mg/d increase in vitamin A intake (RR: 0.94; 95% CI: 0.90, 0.98; P < 0.001). Conclusions: Higher consumption of certain vitamins and carotenoids was associated with a significant decreased risk of ARC in cohort studies, but evidence from RCTs is less clear.

Expression of lens-related microRNAs in transparent infant lenses and congenital cataract.

AIM: To identify the expression of lens-related microRNAs (miRNAs) in the central epithelium of transparent infant lenses and congenital cataract. METHODS: Lens-related miRNAs were retrieved from PubMed database. The expression levels of these miRNAs in transparent infant lenses and congenital cataract were determined by stem-loop reverse transcription-polymerase chain reaction (RT-PCR). miRanda algorithm was used to predict the target genes of these differentially expressed miRNAs. The target mRNA was validated. RESULTS: Six lens-related miRNAs were retrieved from screening PubMed database. The most abundant miRNA in transparent infant lenses according to stem-loop RT-PCR was miR-184. miR-182 was up-regulated in congenital cataract. Contrarily, miR-204 and miR-124 was down-regulated. miR-204 exhibited a more significant decrease in expression than miR-124. In addition, Meis2 was predicted to be the target of miR-204 using miRanda algorithm. miR-204 mimic/antagomir transfection experiments suggested the negative correlation between the expression of miR-204 and Meis2. CONCLUSION: The expression levels of miR-182, miR-204 and miR-124 differ between the central epithelium of transparent infant lens and congenital cataract, suggesting their involvement in the pathogenesis of congenital cataract. miR-204 may act via silencing Meis2 to regulate lens development and congenital cataract formation.

Effect of lutein supplementation on visual function in nonproliferative diabetic retinopathy.

BACKGROUND AND OBJECTIVES: The purpose of this study was to determine whether supplementation with lutein improved visual function in patients with nonproliferative diabetic retinopathy (NPDR). METHODS AND STUDY DESIGN: In this randomized, double-blind, placebo-controlled trial, 31 patients with NPDR were assigned randomly to 10 mg/d of lutein or identical placebo for 36 weeks. Visual performance indices, including visual acuity (VA), contrast sensitivity (CS) and glare sensitivity (GS) at four different spatial frequencies, were measured at baseline, week 18 and 36. RESULTS: At 36 weeks, a slight improvement in VA was found in the lutein group. A significant association was observed between the changes in VA and the corresponding baseline values in treatment group (r=-0.53; p=0.04). At 36 weeks, the lutein treatment group increased CS at four spatial frequencies, and the improvement achieved statistical significance at 3 cycles/degree (p=0.02). The changes in CS at 3 cycles/degree for the lutein group was marginally significantly greater than those for the placebo group (p=0.09). There was also a slight increase in GS in the lutein group up to week 36, however, no significant changes were found over time in any cycles/degree. CONCLUSIONS: In patients with NPDR, supplementation with lutein resulted in potential improvements in CS at low spatial frequency. Further studies are required to determine the possibility that such intervention could be used as an adjunct therapy to prevent vision loss in diabetic patients.

Prevalence and characteristics of ophthalmological extra-intestinal manifestations in Chinese patients with inflammatory bowel disease.

AIM: To investigate the prevalence of ophthalmological extra-intestinal manifestations (O-EIMs) in Chinese patients with inflammatory bowel disease (IBD) and to identify risk factors for the development of O-EIMs. METHODS: The study population consisted of Chinese patients with a definite diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) in a large teaching hospital between January 1995 and December 2014. Demographic and clinical characteristics of patients were extracted retrospectively. RESULTS: In this twenty-year cohort, 645 IBD patients (517 with UC, 128 with CD) were registered. Among them 122 (18.9%) exhibited at least one EIM. Of 13 patients (2.0%) developed O-EIMs, 7 of CD (5.5%) and 6 of UC (1.2%). Clinical ophthalmological manifestations included redness (76.9%), burning (61.5%), pain (38.5%), itching (15.4%) of eyes and vision change (7.7%). O-EIMs included episcleritis (7), uveitis (5) and dry eye (1). O-EIMs were more prevalent in female (odds ratio for male 0.61, 95% confidence interval 0.52-0.73, P<0.0001), and patients who had IBD diagnosis at young age (odds ratio for patients aged >30 years 0.76, 95% confidence interval 0.65-0.88, P<0.0001). CONCLUSION: The frequency of O-EIMs in Chinese patients with IBD is lower than the rates reported in the studies of European and American countries. Episcleritis and uveitis are the most common O-EIMs. O-EIMs are more frequent in patients with CD and more prevalent in female and patients who have IBD diagnosis at young age.

Associations Between the T280M and V249I SNPs in CX3CR1 and the Risk of Age-Related Macular Degeneration.

PURPOSE: Two common single nucleotide polymorphisms (SNPs) in the CX3CR1 gene, T280M and V249I, have been reported to affect the risk of age-related macular degeneration (AMD) in several studies. The aim of the present study was to combine all published data on the relationship between these two variants and AMD susceptibility in a meta-analysis to clarify this association. METHODS: MEDLINE, EMBASE, and ISI Web of Science were searched for all eligible studies on the relationship between AMD and T280M and V249I variants. The pooled odds ratio (OR) with 95% confidence intervals (CIs) for each SNP in the allele frequency, homozygote, second codominant genotype, and dominant genotype models were calculated to evaluate the strength of this association. RESULTS: A total of 3017 AMD cases and 4096 controls from eight studies were involved in this meta-analysis. Both T280M and V249I SNPs exhibited significant associations with increased risk of AMD in the allele (T versus C: OR = 1.43, 95% CI: 1.06-1.91; A versus G: OR = 1.25, 95% CI: 1.01-1.55) and homozygous models (TT versus CC: OR = 2.11, 95% CI: 1.00-4.43; AA versus GG: OR = 1.27, 95% CI: 1.00-1.61), while no significance association was observed for the codominant genotype model. Moreover, studies showing high linkage disequilibrium between these two variants demonstrated a significantly stronger connection between these SNPs and AMD risk, compared with the moderate linkage disequilibrium group. CONCLUSIONS: Significant evidence for a relationship between T280M and V249I variants in CX3CR1 in the homozygote state with increased susceptibility to AMD was reported. Further studies are needed to confirm these findings.

Associations of the G1961E and D2177N variants in ABCA4 and the risk of age-related macular degeneration.

OBJECTIVE: The aim of this study was to identify the relationship between G1961E and D2177N variants in the ABCA4 gene with AMD susceptibility. DESIGN AND METHODS: All eligible studies published up to October 2014 were obtained from MEDLINE, EMBASE, and ISI Web of Science. The pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated to evaluate the strength of this association. RESULTS: Twenty-four studies enrolling 4580 AMD cases and 5180 controls were identified. Both G1961E (OR = 3.22, 95% CI: 1.74-5.95) and D2177N (OR = 2.36, 95% CI: 1.41-3.93) variations showed significant associations with increased risk of AMD. In addition, a more significant relationship in the D2177N mutation with increased risk for AMD was found in Americans (OR = 4.31, 95% CI: 1.90-9.73), while no association was demonstrated in Europeans. For Asians, no carriers of the risk factor A allele in either variant were detected in any of AMD patients and control subjects. CONCLUSIONS: Significant evidence was found for a relationship between the G1961E and D2177N variants in ABCA4 with increased susceptibility to AMD, specifically for Americans. However, large-scale studies are still required to further validate these findings in different ethnicities.

Clinical evaluation of two multifocal intraocular lens implantation patterns.

AIM: To evaluate the visual outcomes and patient satisfaction of two multifocal intraocular lens implantation patterns, with the decision between the two patterns being guided by the patients' choice of visual zones that best suited their lifestyle, or lifestyle zones. METHODS: This is a prospective non-randomized comparative study. The lifestyle zones of 32 consecutive age-related cataract patients (64 eyes) were investigated individually to guide the surgical decision between two multifocal intraocular lens implantation patterns. The first group (MIX) received a combined implantation of a ReZoom NXG1 lens in the dominant eye and a Tecnis ZM900 lens in the other eye. The second group (MATCH) received bilateral ReZoom NXG1 lenses. One year postoperatively, the patients were assessed for binocular uncorrected visual acuity, reading visual acuity, reading speed and depth of focus under different luminance and were surveyed for visual disturbances, satisfaction and complete spectacle independence. RESULTS: According to the determination of lifestyle zones, 18 and 14 patients were included in the MIX and MATCH groups, respectively. One year postoperatively, each of the patients exhibited positive visual outcomes and lifestyle satisfaction, although there were still some differences between the two groups. Generally, patients in the MATCH group had better distance visual acuity than those in the MIX group. In contrast, patients in the MIX group had better near visual acuity, better reading acuity and better reading speed than those in the MATCH group. Between the two groups, there was no clear difference in intermediate visual acuity, and the depths of focus between the two groups were approximately equal. The results of the mean NEI-RQL-42 questionnaire score, overall satisfaction, and complete spectacle independence did not differ between the two groups. CONCLUSION: Different multifocal intraocular lenses implantation patterns can have differing advantages and disadvantages; however, the best results with respect to visual outcome and patient satisfaction can be achieved by taking individual lifestyle zones into account.