Using generative AI to investigate medical imagery models and datasets.

BACKGROUND: AI models have shown promise in performing many medical imaging tasks. However, our ability to explain what signals these models have learned is severely lacking. Explanations are needed in order to increase the trust of doctors in AI-based models, especially in domains where AI prediction capabilities surpass those of humans. Moreover, such explanations could enable novel scientific discovery by uncovering signals in the data that aren't yet known to experts. METHODS: In this paper, we present a workflow for generating hypotheses to understand which visual signals in images are correlated with a classification model's predictions for a given task. This approach leverages an automatic visual explanation algorithm followed by interdisciplinary expert review. We propose the following 4 steps: (i) Train a classifier to perform a given task to assess whether the imagery indeed contains signals relevant to the task; (ii) Train a StyleGAN-based image generator with an architecture that enables guidance by the classifier ("StylEx"); (iii) Automatically detect, extract, and visualize the top visual attributes that the classifier is sensitive towards. For visualization, we independently modify each of these attributes to generate counterfactual visualizations for a set of images (i.e., what the image would look like with the attribute increased or decreased); (iv) Formulate hypotheses for the underlying mechanisms, to stimulate future research. Specifically, present the discovered attributes and corresponding counterfactual visualizations to an interdisciplinary panel of experts so that hypotheses can account for social and structural determinants of health (e.g., whether the attributes correspond to known patho-physiological or socio-cultural phenomena, or could be novel discoveries). FINDINGS: To demonstrate the broad applicability of our approach, we present results on eight prediction tasks across three medical imaging modalities-retinal fundus photographs, external eye photographs, and chest radiographs. We showcase examples where many of the automatically-learned attributes clearly capture clinically known features (e.g., types of cataract, enlarged heart), and demonstrate automatically-learned confounders that arise from factors beyond physiological mechanisms (e.g., chest X-ray underexposure is correlated with the classifier predicting abnormality, and eye makeup is correlated with the classifier predicting low hemoglobin levels). We further show that our method reveals a number of physiologically plausible, previously-unknown attributes based on the literature (e.g., differences in the fundus associated with self-reported sex, which were previously unknown). INTERPRETATION: Our approach enables hypotheses generation via attribute visualizations and has the potential to enable researchers to better understand, improve their assessment, and extract new knowledge from AI-based models, as well as debug and design better datasets. Though not designed to infer causality, importantly, we highlight that attributes generated by our framework can capture phenomena beyond physiology or pathophysiology, reflecting the real world nature of healthcare delivery and socio-cultural factors, and hence interdisciplinary perspectives are critical in these investigations. Finally, we will release code to help researchers train their own StylEx models and analyze their predictive tasks of interest, and use the methodology presented in this paper for responsible interpretation of the revealed attributes. FUNDING: Google.

Preoperative anxiety and postoperative pain associated with cataract surgery under local anesthesia.

INTRODUCTION: Although cataract surgery is a routine outpatient surgery, anxiety and pain remain two significant concerns seen in patients. AIM: To describe preoperative anxiety and postoperative pain related to cataract surgery under local anesthesia and identify the factors determining their occurrence. METHODS: This is a cross-sectional, descriptive and analytical, study which included patients who underwent cataract surgery for the first eye in the ophthalmology department of Habib Bourguiba University Hospital in Sfax-Tunisia. Preoperative anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale. Postoperative pain was measured using the visual analog scale. RESULTS: A total of 203 patients were included with a sex ratio (M/F) of 0.79. The average age was 67.73±9.4 years. The mean overall preoperative anxiety score was 10.8±5.2. The average score for the need for information among patients was 3.45±1.5. The most anxiety-provoking factor was the possibility of surgery failure and loss of the operated eye. The determining factors for anxiety were young age and female gender. The average postoperative pain score in our patients was 3.51±1.8. A weakly positive correlation was noted between pain and duration of the procedure. CONCLUSION: Managing anxiety and pain related to cataract surgery through preoperative education and adequate management is necessary to improve patient comfort and well-being.

Chloroprocaine 3% Gel as a Novel Ocular Topical Anesthetic: Results from a Multicenter, Randomized Clinical Trial in Patients Undergoing Cataract Surgery.

Purpose: To compare the efficacy and safety of a novel ophthalmic anesthetic, chloroprocaine 3% gel to tetracaine 0.5% eye drops in patients undergoing cataract surgery with phacoemulsification. Methods: This was a prospective, randomized, multicenter, active-controlled, masked-observer, parallel group competitive equivalence study. The study comprised 338 patients having routine cataract extraction by clear corneal phacoemulsification, randomized to receive 3 drops of chloroprocaine gel (n = 166) or tetracaine eye drops (n = 172) before surgery. The primary objective of the study was to assess the equivalence of chloroprocaine gel to tetracaine eye drops as proportion of patients with successful ocular surface anesthesia, without any supplementation just before intraocular lens implantation. Safety measurements were pain, irritation, burning, stinging, photophobia, and foreign body sensation, graded by the patient and objective ocular signs. Results: Equivalence was demonstrated, with a somewhat higher success rate of chloroprocaine gel: 152/166 (92.0%) chloroprocaine versus 153/172 (90.5%) tetracaine patients achieved ocular surface anesthesia with no supplementation. Difference in proportions was 1.5% confidence interval [95% CI: (-3.6 to 6.6)] and 90% CI fell within (-10 to 10). Mean onset of anesthesia was 1.35 ± 0.87 min for chloroprocaine and 1.57 ± 1.85 for tetracaine (P = 0.083). Mean duration of anesthesia was 21.57 ± 12.26 min for chloroprocaine and 22.04 ± 12.58 for tetracaine (P = 0.574). No treatment emergent adverse events related to chloroprocaine were reported and no relevant findings related to local tolerance or vital signs were observed in both arms. Conclusions: Results obtained from the present cataract study demonstrated that chloroprocaine 3% ophthalmic gel is safe and effective, representing a valid alternative in ocular topical anesthesia. Clinical Trial Registration number: NCT04685538.

Natural Product Isolation of the Extract of Cleome rupicola Fruits Exhibiting Antioxidant Activity.

Cataracts are the leading cause of blindness worldwide, however, there is currently no drug-based treatment. Plants that exhibit antioxidant properties have shown promising anticataract effects, likely because they supplement the activity of glutathione, the major antioxidant in lens cells. An extract of Cleome rupicola, a desert plant found in the United Arab Emirates, has traditionally been used to treat cataracts. Phytochemical screening of the aqueous extract established the presence of flavonoids, tannins, steroid derivatives, and reducing sugars. Fractioning of extracts from the fruits using high-performance liquid chromatography (HPLC) yielded the isolation of the anthelmintic compound cleomin, and its structure was confirmed using mass spectrometry (MS) and nuclear magnetic resonance (NMR) spectroscopy.

Case of persistent corneal epithelial damage after cataract surgery leading to diagnosis of vitamin A deficiency.

PURPOSE: To report our findings of reduced full-field electroretinograms (ff-ERGs) and abnormal optical coherence tomographic (OCT) images in a patient with poor visual acuity after cataract surgery who was eventually diagnosed with vitamin A deficiency (VAD). METHODS: This was a clinical study of a patient who complained of blurred vision after cataract surgery. To determine the cause of the reduced vision, we recorded full-field electroretinograms (ff-ERGs) to determine the scotopic and photopic status of the retina. We also performed optical coherence tomography to assess the changes in the retinal structure. Serological tests were performed. RESULTS: A 74-year-old man presented with persistent corneal epithelial damages and reduced vision that developed after conventional cataract surgery. OCT showed an interrupted ellipsoid zone, and fundus autofluorescence (FAF) showed a severe hypofluorescence in the retina of the left eye. The scotopic ff-ERGs were severely reduced, and the photopic ff-ERGs were mildly reduced. Serological examinations revealed a vitamin A concentration < 7 IU/dL (normal, 97-316 IU/dL). Based on these findings, we diagnosed the patient with VAD and started treatment with oral vitamin A supplements. After three months, his visual acuity, ff-ERGs, and OCT findings recovered to normal levels. The amplitudes and implicit times of the RETeval flicker ERGs increased to be within the normal range, and the hypofluorescence of the left eye disappeared. The length of the photoreceptor outer segments increased after the vitamin A supplementation. CONCLUSION: Our findings indicate that the ERGs are helpful for diagnosing patients with VAD associated with persistent corneal epithelial damages.

Comparing Peribulbar and Topical Anesthesia in Cataract Surgery among Patients with Cardiovascular Disease.

PURPOSE: To compare topical and peribulbar anesthesia in cataract surgery for hemodynamic changes, rate of complications and pain score in patients with cardiovascular disease. METHODS: A prospective comparative study at a tertiary care center in India. Patients >40 years old with treated/controlled hypertension and cardiovascular disease scheduled for cataract surgery under topical or peribulbar anesthesia were recruited. Heart rate, blood pressure, and ophthalmic and systemic complications were noted: preoperatively, immediately after block, intraoperatively, immediately postoperatively and 1 hour postoperatively. A visual analog scale was used to assess the pain score. RESULTS: A total of 150 patients (75 in each group) underwent cataract surgery. There was a significant rise in pulse rate and blood pressure after peribulbar injection and intraoperatively, which gradually reduced to baseline 1 hour after surgery in both groups (p < 0.001), with systolic blood pressure intraoperatively being significantly greater in the peribulbar group (155.49 ±18.14 mmHg vs. 147.95 ±17.71 mmHg, p = 0.01). The topical group had slightly lower visual analog scale scores (1.12 ± 0.99) than the peribulbar group (1.44 ± 0.90, p = 0.04). CONCLUSIONS: Cataract surgery appears safe in patients with adequately controlled cardiovascular disease, and topical anesthesia may be preferable due to noninvasiveness, adequate analgesia, and minimal effect on hemodynamic parameters. Therefore, hemodynamically stable patients of cardiovascular disease undergoing uncomplicated cataract surgery may be counselled for topical anesthesia.

Mitigation of lens opacification by a functional food in a diabetic rodent model.

The current study was designed to test a functional food (FF) mixture containing aldose reductase inhibitors and antiglycation bioactive compounds for suppressing the onset and progression of cataracts in a diabetic rat model. Two-month-old Sprague Dawley rats were grouped as control (C), diabetes untreated (D), and diabetic rats treated with FF at two doses (FF1 = 1.35 g and FF2 = 6.25 g/100g of diet). Diabetes was induced by a single injection of streptozotocin. The FF is a mixture of amla, turmeric, black pepper, cinnamon, ginger, and fenugreek added to the rodent diet. The status of cataracts was monitored weekly by a slit lamp examination for 20 weeks, after which animals were sacrificed to collect eye lenses. Feeding FF1 and FF2 to diabetic rats yielded a significant anti-hyperglycaemic effect and marginally prevented body weight loss. FF delayed cataract progression, and FF2 showed better efficacy than FF1. FF prevented the loss of lens crystallins and their insolubilization in diabetic rats. The antioxidant potential of FF was evident with the lowered protein carbonyls, lipid peroxidation, and prevention of altered antioxidant enzyme activities induced by diabetes. These studies demonstrate the efficacy of plant-derived dietary supplements against the onset and progression of cataracts in a well-established rat model of diabetic eye disease.

Topical and subconjunctival anesthesia versus topical anesthesia alone in patients with senile cataracts undergoing phacoemulsification: a double-blind randomized controlled trial.

BACKGROUND: This study compared topical anesthesia to a combination of topical anesthesia and subconjunctival anesthesia for phacoemulsification. METHODS: This double-blinded parallel placebo-controlled randomized trial involved senile cataract patients scheduled for phacoemulsification between May and December 2022. Patients were randomly assigned to receive either topical anesthesia with 0.5% tetracaine hydrochloride and subconjunctival balanced salt solution injection (Control group) or topical anesthesia and subconjunctival injection with 2% lidocaine (Lidocaine group). Baseline parameters, cataract grades, and various outcomes were recorded, including pain scores at specific time points, patient cooperation scores, requests for additional anesthesia, and complications. Statistical methods included Fisher's exact test, the t-test, ordinal logistic regression, and linear regression with robust standard errors. RESULTS: In total, 176 patients were included in the study after excluding 33 patients. A significant reduction in immediate postoperative pain was achieved in the Lidocaine group (p < 0.001) and was maintained for 2 h (p = 0.011). Additionally, better cooperation was observed in this group (p = 0.038). However, patients in the Lidocaine group experienced more pain during the subconjunctival injection (p = 0.001) and a significant increase in subconjunctival hemorrhage related to the injection (p < 0.001). Despite this, the rates of surgical complications were comparable between the groups, and all phacoemulsification procedures were successfully completed using the assigned anesthetic technique. CONCLUSIONS: The addition of subconjunctival lidocaine injection to topical anesthesia reduced postoperative pain and improved patient cooperation during phacoemulsification. However, the lidocaine injection was painful, and it carried a higher risk of spontaneous-relief subconjunctival hemorrhage. TRIAL REGISTRATION: Trial Registration Number: TCTR20220804003, date of registration August 4, 2022, retrospectively registered.

Review on the potential roles of traditional Chinese medicines in the prevention, treatment, and postoperative recovery of age-related cataract.

ETHNIC PHARMACOLOGICAL RELEVANCE: Cataract is the most common cause of blindness worldwide, a visual disorder caused by a clouded lens that seriously affects People's Daily lives. Age-related cataract (ARC) is the most common type of cataract due to long-term combined effects of many factors, and its pathogenesis is varied. At present, the surgery is the main treatment for cataracts, but it is still limited to the prevention, treatment of early cataracts and the postoperative complications care. While, its drug treatments are still in the stage of exploration and research. Traditional Chinese Medicine (TCM), a unique resource in China, is conceived under the guidance of traditional Chinese medicine theory and has little toxicity and side effects, but it has made great progress in the treatment and prevention of ARC. AIM OF THIS REVIEW: This review presents an overview of the pathogenesis of ARC in both traditional and modern medicines and summarizes the history and therapeutic effect of TCM on ARC including their formula, crude drugs and active components, and also the other auxiliary methods. METHODS: A number of recognized databases like SciFinder, PubMed, Science Direct, Google Scholar, and China National Knowledge Infrastructure (CNKI) were extensively explored by using keywords and phrases such as "cataract", "age-related cataract", "traditional medicine", "ethnopharmacology", "herbs", "medicinal plants", or other relevant terms, and the plants/phytoconstituents that are evaluated in the models of age-related cataract. As well as the current TCM adjuvant therapy used in the clinical treatment were summarized. RESULTS: TCM revealed to plays an active role in treating age-related cataract, via multi-pathway and multi-target, and can treat or delay ARC by inhibiting abnormal glucose metabolism, antioxidant damage, inhibiting LEC apoptosis, and so on, which is in concordance with the good effects of the global use of TCM in clinical application. Concerning the early prevention and treatment of cataract and postoperative complications, TCM and auxiliary methods remain to achieve better clinical effects. CONCLUSION: ARC belongs to the category of "Yuan Yi Nei Zhang" in TCM theory, showing that there are many causes of ARC including aging, and kidney-yang, spleen, sperm and blood deficiencies. At the same time, the viscera gradually decline, as well as yin or yang progressively become weak, especially in the elder people. So, TCM could be mainly based on liver, kidney, and spleen syndrome differentiation, personalizing diagnosis and treatment, following multiple targets, regulating fundamentally yin and yang, and thus justifying the advantages of Chinese medicine in the prevention and treatment of ARC.

Pain experience in patients undergoing topical anesthesia alone versus topical plus intracameral anesthesia during cataract surgery.

PURPOSE: To evaluate and compare the pain experience and discomfort during cataract surgery and over the 24 hours after surgery in patients undergoing either topical anesthesia alone or topical anesthesia plus intracameral anesthesia, provided by using a standard topical anesthesia regimen and a 0.2-mL dose of Mydrane®. METHODS: Prospective study involving 100 patients who underwent cataract surgery receiving either topical anesthesia alone (group 1, n = 50) or topical anesthesia plus intracameral anesthesia (group 2, n = 50) between January 2021 and March 2022. The pain experienced by patients during and after surgery was assessed using a pain scale and a questionnaire. One hour after surgery, patients were asked to rate the intensity of discomfort they experienced throughout the procedure by pointing to a 0-100 Visual Analogue Scale (VAS). RESULTS: According to VAS measurements, patients who underwent surgery under topical anesthesia reported more significant pain than those who underwent surgery under topical anesthesia plus intracameral anesthesia during and over the 24 hours after surgery. (p = 0.02 and p = 0.01, respectively). Patients undergoing topical anesthesia had 2.34-fold greater odds of having pain during surgery [95% Confidence Interval (CI): 1.58-5.25, p = 0.03]. CONCLUSIONS: Topical anesthesia plus intracameral anesthesia lower intraoperative and postoperative pain levels, improving patient cooperation and representing a useful analgesic delivery method in cataract surgery.

The role of dietary vitamin A in mechanisms of cataract development in the teleost lumpfish (Cyclopterus lumpus L).

Lumpfish (Cyclopterus lumpus L) are highly prone to cataract development in the wild and in culture. There is evidence that cataract in farmed fish is related to nutrition. However, both the nutrients and the mechanisms involved in cataract development in lumpfish are not clear. Here we investigated the mechanisms involved and the role of dietary vitamin A in cataract development in a cultured lumpfish population. Cultured lumpfish were fed three diets differing only in vitamin A supplementation level (5000, 15,000 and 120,000 IU/kg) over an 18-month period, and fish weight, cataract frequencies and severities were determined. Western blotting and immunohistochemistry were performed on lens tissue to measure the levels of oxidative stress, and apoptosis. The lowest levels of vitamin A significantly reduced cataract frequencies in adult lumpfish and resulted in less severe cataract and increased weight in males. Oxidative stress levels in the lens were positively correlated with vitamin A intake. Apoptosis was observed at high levels in lenses with severe cataract. Oxidative stress and apoptosis levels were the highest in regions of the lens with severe, advanced cataract pathology when compared to regions with no visible pathology. These results suggest that higher vitamin A intake contributes to cataract development through an oxidative stress pathway, and that both oxidative stress and apoptosis are involved in advanced stages of cataract in lumpfish.

A review of using Traditional Chinese Medicine in the management of glaucoma and cataract.

Traditional Chinese Medicine has a long history in ophthalmology in China. Over 250 kinds of Traditional Chinese Medicine have been recorded in ancient books for the management of eye diseases, which may provide an alternative or supplement to current ocular therapies. However, the core holistic philosophy of Traditional Chinese Medicine that makes it attractive can also hinder its understanding from a scientific perspective - in particular, determining true cause and effect. This review focused on how Traditional Chinese Medicine could be applied to two prevalent ocular diseases, glaucoma, and cataract. The literature on preclinical and clinical studies in both English and Chinese on the use of Traditional Chinese Medicine to treat these two diseases was reviewed. The pharmacological effects, safety profile, and drug-herb interaction of selected herbal formulas were also investigated. Finally, key considerations for conducting future Traditional Chinese Medicine studies are discussed.

The Effect of Music on Operative Anxiety markers in patients undergoing Cataract Surgery: Adual centre cross-sectional comparative study.

OBJECTIVE: To determine the effect of intraoperative music on various markers of anxiety among adult patients undergoing small incision cataract surgery. METHODS: This was a hospital-based, age-sex matched, comparative cross-sectional study of consenting 144 adult participants aged 46 years and above with operable, age-related cataracts undergoing small incision cataract surgery under local anaesthesia in two ophthalmic centres. All participants were allotted into two equal groups consisting of 72 participants in the experimental group (exposed to music of their choice) and 72 participants in the control group (no music exposure). Blood pressure, pulse rate and salivary cortisol assay levels were measured. Data obtained were analyzed using statistical package for social sciences (IBM SPSS version 23.0). RESULTS: One hundred and forty-four participants with total male-to-female ratio of 1:2.1 were studied. Gender ratio was 1:2.3 and 1:2.0 and the median age (Q1-Q3) of 65.00 (55.5-71.5) years and 65.50 (56.5-72.0) years for music and non-music groups respectively. Participants in the music group showed a statistically significant reduction in systolic blood pressure, diastolic blood pressure and pulse rate (p < 0.05) except at baseline. The mean value salivary cortisol level showed a statistically significant decrease in both groups from baseline for music (23.91ng/ml) and nonmusic (19.12ng/ml) group (p<0.001) respectively. Similarly, participants in the music group showed a statistically significant reduction of Spielberger State anxiety score after music intervention compared to control (p<0.001). CONCLUSIONS: This study demonstrated the effectiveness of music in decreasing anxiety indicators during cataract surgery with markers like salivary cortisol assay, pulse rate, systolic and diastolic blood pressure.

OBJECTIF: Déterminer l'effet de la musique intra-opératoire sur divers marqueurs d'anxiété chez les patients adultes subissant une chirurgie de la cataracte par petite incision. MÉTHODES: Il s'agissait d'une étude transversale comparative, basée à l'hôpital, appariée selon l'âge et le sexe, portant sur 144 participants adultes consentants âgés de 46 ans et plus, présentant des cataractes liées à l'âge opérables et subissant une chirurgie de la cataracte par petite incision sous anesthésie locale dans deux centres ophtalmologiques. Tous les participants ont été répartis en deux groupes égaux, soit 72 participants dans le groupe expérimental (exposé à de la musique de leur choix) et 72 participants dans le groupe témoin (pas d'exposition à la musique). La pression artérielle, la fréquence cardiaque et les taux de cortisol salivaire ont été mesurés. Les données obtenues ont été analysées à l'aid du logiciel statistique pour les sciences sociales (IBM SPSS version 23.0). RÉSULTATS: Cent quarante-quatre participants avec un rapport total d'hommes à femmes de 1:2,1 ont été étudiés. Le ratio hommes-femmes était de 1:2,3 et 1:2,0, avec un âge médian (Q1-Q3) de 65,00 (55,5-71,5) ans et 65,50 (56,5-72,0) ans pour les groupes musique et non-musique, respectivement. Les participants du groupe musique ont montré une réduction statistiquement significative de la pression artérielle systolique, de la pression artérielle diastolique et de la fréquence cardiaque (p < 0,05) sauf au départ. La valeur moyenne du taux de cortisol salivaire a montré une diminution statistiquement significative dans les deux groupes par rapport au départ pour le groupe musique (23,91 ng/ml) et le groupe non-musique (19,12 ng/ml) (p <0,001) respectivement. De même, les participants du groupe musique ont montré une réduction statistiquement significative du score d'anxiété à l'état de Spielberger après l'intervention musicale par rapport au groupe témoin (p <0,001). CONCLUSIONS: Cette étude a démontré l'efficacité de la musique dans la diminution des indicateurs d'anxiété pendant la chirurgie de la cataracte, avec des marqueurs tels que le dosage du cortisol salivaire, la fréquence cardiaque, la pression artérielle systolique et diastolique. Mots-clés: Musique binaurale, peur, anxiété, stress, chirurgie de la cataracte par petite incision, anxiolytique non pharmacologique.

Effect of music on preoperative anxiety using the Hamilton State-Trait Anxiety Inventory (STAI) in patients undergoing cataract surgery in the University of Nigeria Teaching Hospital, Ituku Ozalla.

INTRODUCTION: To determine the effectiveness of music in allaying preoperative anxiety in patients scheduled for and undergoing surgery for age-related cataract. METHODS: This is a randomised interventional study of individuals aged 50 years and above who were scheduled for and undergoing cataract surgery under regional anaesthesia, with music (test group) randomly matched with similar individuals undergoing the same procedure but without music (control group). The surgeries were performed at the Ophthalmology Theatre of the University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu, Nigeria. Using a systematic random sampling method, a total of 98 patients were selected into two groups. Both groups completed the State-Trait Anxiety Inventory (STAI) Questionnaire at baseline, immediately on entrance into the preoperative room and 5 min after intervention. The first group listened to music while the second group did not listen to music. Results were analysed using the SPSS V.20 and analysis of variance was used to compare means of variables measured at baseline, preoperative before intervention and preoperative after intervention. Categorical variables were compared using the χ2 test. Student's t-test was used to analyse the continuous variables. RESULTS: There was an increase in the anxiety scores in the two groups on entrance into the preoperative room, however, 5 min into intervention, there was a significant decrease in the anxiety scores in the music group and a progressive increase in the anxiety scores in the group without music. CONCLUSION: Music has a positive effect on preoperative anxiety evidenced by the indirect effect of music on the STAI anxiety scores.

Epigallocatechin gallate delays age-related cataract development via the RASSF2/AKT pathway.

Age-related cataract (ARC) is a common eye disease, the main cause of which is oxidative stress-mediated apoptosis of lens epithelial cells (LECs). Epigallocatechin gallate (EGCG) is the most potent antioxidant in green tea. Our results demonstrated that EGCG could effectively reduce apoptosis of LECs and retard lens clouding in aged mice. By comparing transcriptome sequencing results of three groups of mice (young control, untreated aged, and EGCG-treated) and screening using GO and KEGG analyses, we selected RASSF2 as the effector gene of EGCG for mechanistic exploration. We verified that the differential expression of RASSF2 was associated with the occurrence of ARC in clinical samples and mouse tissues by immunohistochemistry and western blotting, respectively. We showed that high RASSF2 expression plays a crucial role in the oxidative induction of apoptosis in LECs, as revealed by overexpression and interference experiments. Further studies showed that RASSF2 mediates the inhibitory effect of EGCG on apoptosis and ARCogenesis in LECs by regulating AKT (Ser473) phosphorylation. In this study, we found for the first time the retarding effect of EGCG on lens clouding in mice and revealed the mechanism of action of RASSF2/AKT in it, which provides a theoretical basis for the targeted treatment of EGCG.

Evaluating the accuracy of a cataract surgery simulation video in depicting patient experiences under conscious anesthesia.

PURPOSE: To evaluate the accuracy of a point-of-view cataract surgery simulation video in representing different subjective experiences of patients undergoing the procedure. METHODS: One hundred consecutive post-cataract-surgery patients were shown a short simulation video of the surgery obtained through a porcine eye model during the first postoperative week. Patients then answered a multiple-choice questionnaire regarding their visual and tactile intraoperative experiences and how those experiences matched the simulation. RESULTS: Of the patients surveyed (n = 100), 78% (n = 78) recalled visual experiences during surgery, 11% recalled pain (n = 11), and 6.4% (n = 5) recalled frightening experiences. Thirty-six percent of patients (n = 36) were interviewed after their second cataract surgery; there was no statistically significant difference between anxiety scores reported before the first eye surgery and second eye surgery (p = 0.147). Among all patients who recalled visual experiences (n = 78), nearly half (47.4%) reported that the video was the same/similar to their experience. Forty-eight percent of the patients recommended future patients to watch the video before their procedures, and more than a third (36%) agreed that watching the video before surgery would have helped them to relax. CONCLUSIONS: Our model reflects the wide range of subjective patient experiences during and after surgery. The high percentage of patients who found the video accurate in different ways suggests that, with more development, point-of-view cataract simulation videos could prove useful for educational or clinical use. Further research may be done to confirm the simulation's utility, by screening the video for subjects before operations.

Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 11, techniques and complications of local anesthesia for cataract surgery in the United Kingdom.

PURPOSE: To describe variation in local anesthesia techniques and complications over a 10-year period for cataract surgery in the United Kingdom. SETTING: Reporting centers to the Royal College of Ophthalmologists (RCOphth) National Ophthalmology Database (NOD). DESIGN: Retrospective cross-sectional register-based study. METHODS: Data from the RCOphth NOD were used. Eligible for analysis were 1 195 882 cataract operations performed using local anesthesia between April 1, 2010, and March 31, 2020, in 80 centers. RESULTS: Overall, topical anesthesia alone was used in 152 321 operations (12.7%), combined topical and intracameral in 522 849 (43.7%), sub-Tenon in 461 175 (38.6%), and peribulbar/retrobulbar in 59 537 (5.0%). In National Health Service (NHS) institutions, 48.3% of operations were topical with/without intracameral vs 88.7% in independent sector treatment centers (ISTCs). 45.9% were sub-Tenon in NHS vs 9.6% in ISTCs. 5.8% were peribulbar/retrobulbar in NHS vs 1.7% in ISTCs. Anesthetic complication rates decreased from 2.7% in the 2010 NHS year to 1.5% in the 2019 NHS year (overall, 2.1% for NHS; 0.2% for ISTCs). Overall anesthetic complication rates were 0.3%, 0.3%, 3.5%, and 3.1% for topical alone, combined topical/intracameral, sub-Tenon, and peribulbar/retrobulbar, respectively. Complication rates were higher for sharp-needle anesthesia (peribulbar/retrobulbar) in patients taking warfarin rather than direct oral anticoagulants (4.8% vs 3.1%; P = .024). Considerable variation was observed between centers on anesthetic choices and anesthetic complication rates. CONCLUSIONS: Combined topical and intracameral is the most common choice of anesthesia for cataract surgery in the United Kingdom and is associated with lower anesthetic-related complication rates than sub-Tenon and peribulbar/retrobulbar anesthesia. Variation in the anesthetic choice exists between centers and between NHS and ISTC sectors.

Astaxanthin ameliorates oxidative stress in lens epithelial cells by regulating GPX4 and ferroptosis.

Ferroptosis is a form of regulated cell death closely associated with oxidative stress and mitochondrial dysfunction and is characterised by the accumulation of reactive oxygen species (ROS) and lipid species and iron overload. Damage to human lens epithelial cells (LECs) is associated with age-related cataract progression. Astaxanthin (ATX), a carotenoid with natural antioxidant properties, counteracts ferroptosis in the treatment of various degenerative diseases. However, this mechanism has not been reported with respect to cataract treatment. In this study, the differential expression levels of glutathione peroxidase 4 (GPX4) in the lens of young and aged mice were analysed. Continuous ATX supplementation for 8 months upregulated GPX4 expression in the mouse LECs and delayed the progression of ferroptosis. Upon treatment with erastin, ROS and malondialdehyde accumulated and the mitochondrial membrane potential decreased. At the same time, the expressions of GPX4, SLC7A11, and ferritin were suppressed in human LECs. All of these phenomena were partially reversed by ATX and Fer-1, a ferroptosis inhibitor. This study confirmed that the ATX-mediated targeting of GPX4 might alleviate human LECs damage by inhibiting ferroptosis and ameliorating oxidative stress and that this could represent a promising therapeutic approach for age-related cataract.

Effectiveness of rb-bFGF Eye Drops for Post-Cataract Surgery Dry Eye and Observation of Changes in Tear Secretion and Corneal Damage in Patients.

Objective: Dry eye syndrome after cataract surgery is a common complication that may affect the patient's visual comfort and quality of life. Because the surgery may affect the secretion and quality of tears in the eye, resulting in dry and uncomfortable eyes.This study aimed to investigate the therapeutic effects of recombinant bovine basic fibroblast growth factor (rb-bFGF) eye drops on dry eye syndrome after cataract surgery and to analyze its impact on tear secretion and corneal injury. Methods: This is a retrospective study. A total of 126 patients (126 eyes) with dry eye syndrome after cataract surgery were treated between January 2021 and October 2022. patients were randomly divided into a study group (64 patients, 64 eyes) and a control group (62 patients, 62 eyes). Both groups were treated with sodium hyaluronate eye drops, while the study group received rb-bFGF eye drops for four weeks in addition to the sodium hyaluronate eye drops. The clinical efficacy, results of tear secretion test (SIT), tear film break-up time (BUT), corneal fluorescein staining, corneal topography examination, oxidative stress indicators, ocular surface disease index (OSDI) score, and drug adverse reactions were compared between the two groups. Results: The study group exhibited a significantly higher total effective treatment rate (96.88%) compared to the control group (85.48%), suggesting the enhanced efficacy of rb-bFGF eye drops. Moreover, the study group demonstrated extended tear secretion length and tear film break-up time, indicating improved tear film stability and ocular surface health. Additionally, the study group showed reduced corneal fluorescein staining score and improved corneal surface regularity index, indicative of enhanced corneal integrity and smoothness. Notably, tear superoxide dismutase levels were elevated, while lipid peroxide levels were lowered in the study group, underscoring the potential antioxidative effects of rb-bFGF. The study group also exhibited a lower OSDI score, suggesting reduced ocular discomfort and improved quality of life. Although the study group had a slightly higher incidence of adverse reactions (9.38%) compared to the control group (8.06%), the difference was not statistically significant. Particularly significant is the statistical significance highlighting the heightened total effective treatment rate in the study group, indicating the potential of rb-bFGF eye drops in promoting favorable therapeutic outcomes. Conclusion: rb-bFGF eye drops are safe and effective in treating dry eye syndrome after cataract surgery. They can help regulate tear secretion, repair corneal damage, and improve dry eye symptoms. Despite the retrospective design and relatively small sample size of this study, further randomized controlled trials and larger sample size may be needed to verify the robustness of the results, but this study is important for guiding the treatment strategy and optimizing patient care for dry eye after cataract surgery.