ABSTRACT
PURPOSE: To investigate the effect of posterior keratometry (PK) on the accuracy of 10 intraocular lens (IOL) power calculation formulas using standard keratometry (K) and total keratometry (TK). METHODS: This is a retrospective consecutive case-series study. The IOL power was calculated using K and TK measured by IOLMaster 700 in 6 new-generation formulas (Barrett Universal II, Emmetropia Verifying Optical (EVO) 2.0, RBF Calculator 3.0, Hoffer QST, Kane, and Ladas Super Formula) and 4 traditional formulas (Haigis, Hoffer Q, Holladay 1, and SRK/T). The arithmetic prediction error (PE) and mean absolute PE (MAE) were evaluated. The locally-weighted scatterplot smoothing was performed to assess the relationship between PE and PK. RESULTS: A total of 576 patients (576 eyes) who underwent cataract surgery were included. Compared with using K, all formulas using TK showed a hyperopic shift in the whole group. Specifically, for eyes with PK exceeding -5.90 D, all formulas using TK exhibited a hyperopic shift (all P < 0.001), while eyes with PK less than -5.90 D showed a myopic shift (all P < 0.001). The MAE of new-generation formulas calculated with TK and K showed no statistical differences, while the MAE of traditional formulas with TK was larger (TK: 0.34 ~ 0.43 D; K: 0.33 ~ 0.42 D, all P < 0.05). CONCLUSIONS: The prediction bias of formulas with TK increased as PK deviated from -5.90 D. TK did not improve the prediction accuracy of new-generation formulas, and even performed worse in traditional formulas.
Subject(s)
Biometry , Cornea , Lenses, Intraocular , Optics and Photonics , Refraction, Ocular , Humans , Retrospective Studies , Refraction, Ocular/physiology , Female , Male , Biometry/methods , Aged , Cornea/diagnostic imaging , Reproducibility of Results , Middle Aged , Visual Acuity/physiology , Phacoemulsification/methods , Aged, 80 and over , Follow-Up Studies , Lens Implantation, Intraocular/methodsABSTRACT
Th17 cells are principal mediators of many autoimmune conditions. Recently, memory Th17 cells have been revealed as crucial in mediating the chronicity of various refractory autoimmune disorders; however, the underlying mechanisms maintaining memory Th17 cells have remained elusive. Here, using a preclinical model of ocular autoimmune disease we show that both IL-7 and IL-15 are critical for maintaining pathogenic memory Th17 cells. Neutralization of these cytokines leads to substantial reduction of memory Th17 cells; both IL-7 and IL-15 provide survival signals via activating STAT5, and IL-15 provides additional proliferation signals via activating both STAT5 and Akt. Topical neutralization of ocular IL-7 or IL-15 effectively reduces memory Th17 cells at the inflammatory site and draining lymphoid tissues, while topical neutralization of IL-17 alone, the major pathogenic cytokine secreted by Th17 cells, does not diminish memory Th17 cells at the draining lymphoid tissues. Our results suggest that the effective removal of pathogenic memory Th17 cells via abolishing environmental IL-7 or IL-15 is likely to be a novel strategy in the treatment of autoimmune diseases.
Subject(s)
Autoimmunity , Interleukin-15/metabolism , Interleukin-7/metabolism , Th17 Cells/immunology , Th17 Cells/metabolism , Animals , Apoptosis , Autoimmune Diseases/immunology , Autoimmune Diseases/metabolism , Autoimmune Diseases/pathology , Biomarkers , Disease Models, Animal , Dry Eye Syndromes/immunology , Dry Eye Syndromes/metabolism , Dry Eye Syndromes/pathology , Female , Immunologic Memory , Mice , Proto-Oncogene Proteins c-akt/metabolism , Receptors, Interleukin-15/genetics , Receptors, Interleukin-15/metabolism , Receptors, Interleukin-7/genetics , Receptors, Interleukin-7/metabolism , STAT5 Transcription Factor/metabolism , Signal Transduction , T-Lymphocyte Subsets/immunology , T-Lymphocyte Subsets/metabolismABSTRACT
Sensitive periods and experience-dependent plasticity have become core issues in visual system development. Converging evidence indicates that visual experience is an indispensable factor in establishing mature visual system circuitry during sensitive periods and the visual system exhibits substantial plasticity while facing deprivation. The mechanisms that underlie the environmental regulation of visual system development and plasticity are of great interest but need further exploration. Here, we investigated a unique sample of human infants who experienced initial stage blindness (beginning at birth and lasting for 2-8 months) before the removal of bilateral cataracts. Retinal thickness (RT), axial length (AL), refractive status, visual grating acuity and genetic integrity were recorded during the preoperative period or at surgery and then during follow-up. The results showed that the development of the retina is malleable and associated with external environmental influences. Our work supported that the retina might play critical roles in the development of the experience-dependent visual system and its malleability might partly contribute to the sensitive period plasticity.
Subject(s)
Blindness/physiopathology , Cataract/congenital , Child Development/physiology , Visual Pathways/growth & development , Blindness/etiology , Blindness/pathology , Cataract/complications , Cataract Extraction , Humans , Infant , Longitudinal Studies , Neuronal Plasticity/physiology , Refraction, Ocular/physiology , Retina/growth & development , Retina/pathology , Retina/physiopathology , Tomography, Optical Coherence , Visual Acuity/physiology , Visual Pathways/physiopathologyABSTRACT
Blood-retinal barrier (BRB) breakdown is one of the primary causes of diabetic retinopathy (DR). The pro-inflammatory factor interleukin-1ß (IL-1ß) was reported to be involved in the induction of BRB breakdown during the pathogenesis of DR. In the present study, we investigated the protective effect of tetramethylpyrazine (TMP), a major active component of the traditional herb Ligusticum chuanxiong, on IL-1ß-induced cell death of the rat retinal capillary endothelial TR-iBRB2 cells. Our results showed that IL-1ß-induced cell dysfunction in TR-iBRB2 cells via inducing nitrative/oxidative stress; however, such effect was attenuated with the pre-treatment of TMP. The cellular protective effect of TMP was likely to be mediated through the inhibition of inducible nitric oxide synthase (iNOS) expression and leukostasis as well as suppression of reactive oxygen species (ROS) generation, mitochondrial dysfunction and MAPKs activation. These findings significantly contribute to a better understanding of the protective effect of TMP in DR and form the basis of the therapeutic development of TMP in treating such disease in the future.
Subject(s)
Blood-Retinal Barrier/drug effects , Blood-Retinal Barrier/metabolism , Endothelial Cells/drug effects , Endothelial Cells/metabolism , Interleukin-1beta/metabolism , Nitrates/metabolism , Oxidative Stress , Pyrazines/pharmacology , Animals , Apoptosis/drug effects , Cell Adhesion/drug effects , Cell Line , Cell Nucleus/metabolism , Gene Expression Regulation/drug effects , Intercellular Adhesion Molecule-1/genetics , Intercellular Adhesion Molecule-1/metabolism , Interleukin-1beta/pharmacology , Leukocytes/drug effects , Leukocytes/metabolism , Mitochondria/drug effects , Mitochondria/metabolism , Mitogen-Activated Protein Kinases/metabolism , NF-kappa B/metabolism , Nitric Oxide Synthase Type II/genetics , Nitric Oxide Synthase Type II/metabolism , Oxidative Stress/drug effects , Phosphorylation , Protective Agents/pharmacology , Protein Transport/drug effects , Rats , Reactive Oxygen Species/metabolismABSTRACT
PURPOSE: To investigate the between-eye differences of the crystalline lens in subjects with unilateral high myopia and assess its contribution to the interocular refractive error disparity. METHODS: Children and adolescents with unilateral high myopia, defined as cycloplegic spherical equivalent (SE) ≤ -5D in one eye and ≥ -3D in the other eye, were recruited. Ocular biometric parameters, including axial length (AL) and lens thickness (LT), were measured by IOLMaster 700. Other lens-related parameters, including anterior lens radius of curvature (ALR) and posterior lens radius of curvature (PLR), were measured by CASIA2 swept-source optical coherence tomography. Lens power (LP) was calculated using Bennett's formula. Paired t-test was used to assess the between-eye difference in biometric parameters, and multiple regression analysis was used to assess factors associated with the between-eye SE difference. RESULTS: Ninety-one participants (6-18 years of age; 52.75% girls) were included. The highly myopic eyes showed significantly lower LP (P < 0.001) and smaller ALR (P < 0.001) than the contralateral eyes, while no significant difference was found in central LT. In both eyes, ALR was significantly related to SE (P = 0.001 and P = 0.006, respectively); while LT was not associated with SE (P = 0.051 and P = 0.052, respectively). Paired-eye analysis showed that the between-eye difference in ALR was the only lenticular parameter significantly associated with the between-eye difference in SE (P = 0.005). CONCLUSION: In highly myopic eyes, the crystalline lens reduced total power but morphologically changed to a more curved shape without significant lens thinning, suggesting that the LP loss is mainly achieved by reducing its internal power in high myopes.
Subject(s)
Lens, Crystalline , Myopia , Refractive Errors , Child , Female , Humans , Adolescent , Male , Eye , Myopia/complications , Refraction, Ocular , Refractive Errors/complications , Axial Length, EyeABSTRACT
PURPOSE: To determine whether correcting the axial length (AL) measurement error of the IOLMaster 700 could improve the refractive prediction accuracy in silicone oil-filled eyes. METHODS: This study included 265 cataract patients (265 eyes) with silicone oil tamponade who were scheduled for phacoemulsification with intraocular lens (IOL) implantation. The performances of various formulas, including Barrett Universal II, Emmetropia Verifying Optical, Hoffer-QST, Kane, Ladas Super Formula, Pearl-DGS, Radial Basis Function and traditional formulas (Haigis, Hoffer Q, Holladay 1 and SRK/T), were evaluated. The refractive prediction errors (PE) calculated with measured AL (ALmeas) and corrected AL with silicone oil adjustment (SOAL) were compared. Subgroup analysis was performed based on the ALmeas (<23 mm; 23-26 mm; ≥26 mm). RESULTS: Using SOAL significantly reduced the hyperopic PE of formulas when compared to ALmeas (-0.05 to 0.17 D vs 0.15 to 0.38 D, p < 0.001). After applying AL correction, all formulas showed a lower mean absolute PE (0.47-0.57 D vs 0.50-0.69 D). The percentage of eyes within ±1.0 D of PE increased from 84.91%-88.68% to 89.81%-91.32% for new formulas and from 78.11%-83.40% to 85.66%-88.68% for traditional formulas, with the use of SOAL. Subgroup analysis showed that the majority of formulas with SOAL in prediction accuracy for eyes with an AL ≥26 mm (p < 0.05). CONCLUSIONS: The refractive prediction accuracy in silicone oil-filled eyes was improved by correcting the AL measurement error of the IOLMaster 700, especially for long eyes.
Subject(s)
Axial Length, Eye , Phacoemulsification , Refraction, Ocular , Silicone Oils , Humans , Silicone Oils/administration & dosage , Female , Male , Axial Length, Eye/diagnostic imaging , Refraction, Ocular/physiology , Aged , Phacoemulsification/methods , Middle Aged , Visual Acuity/physiology , Biometry/methods , Retrospective Studies , Endotamponade/methods , Reproducibility of Results , Refractive Errors/physiopathology , Refractive Errors/diagnosis , Lens Implantation, Intraocular/methods , Lenses, Intraocular , Aged, 80 and overABSTRACT
PURPOSE: To evaluate the performance of intraocular lens (IOL) calculation formulas and the effect of anterior chamber depth (ACD), axial length (AL) and lens thickness (LT) on the prediction accuracy in shallow ACD eyes. METHODS: This retrospective, consecutive case-series study included 648 eyes of 648 patients with an ACD < 3.0 mm who underwent phacoemulsification and IOL implantation. Eleven formulas were evaluated: Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO) 2.0, Hill-Radial Basis Function (RBF) 3.0, Hoffer QST, Kane, Olsen, Pearl-DGS and traditional formulas (Haigis, Hoffer Q, Holladay 1 and SRK/T). Subgroup analysis was performed based on ACD, AL and LT. RESULTS: Overall, the Hoffer QST and Kane showed no systematic bias. The Kane, EVO 2.0, Hill-RBF 3.0 and Hoffer QST had relatively lower mean absolute error and higher percentages of prediction error within ±0.5 D. For the ACD of 2.5-3.0 mm and AL < 22.0 mm subgroup, the Pearl-DGS exhibited the lowest MAE (0.45 D) and MedAE (0.41 D). Most formulas had a significant myopic bias (-0.43 to -0.18 D, p < 0.05) in the LT < 4.3 mm subgroup and a significant hyperopic bias (0.09-0.29 D, p < 0.05) in the LT ≥ 5.1 mm subgroup. CONCLUSION: The Kane and Hoffer QST were recommended for shallow ACD eyes. In eyes with an ACD between 2.5 and 3.0 mm and a short AL, the Pearl-DGS showed excellent performance. Clinicians need to fine-tune the target refraction according to LT in shallow ACD eyes.
Subject(s)
Anterior Chamber , Axial Length, Eye , Biometry , Lenses, Intraocular , Refraction, Ocular , Humans , Anterior Chamber/diagnostic imaging , Retrospective Studies , Male , Female , Biometry/methods , Aged , Refraction, Ocular/physiology , Middle Aged , Phacoemulsification , Reproducibility of Results , Visual Acuity/physiology , Optics and Photonics , Lens Implantation, Intraocular , Aged, 80 and overABSTRACT
Importance: Capsular tension rings (CTRs) can support weak zonules and inhibit capsular shrinkage, thus potentially reducing intraocular lens (IOL) decentration and tilt. However, it has been debated whether CTRs can reduce IOL decentration and tilt in highly myopic eyes and whether CTR implantation is necessary for all highly myopic eyes. Objective: To evaluate the influence of CTR implantation on IOL decentration and tilt in highly myopic eyes. Design, Setting, and Participants: This randomized clinical trial was conducted between November 2021 and September 2023 at the Zhongshan Ophthalmic Center, Guangzhou, China. Patients with cataract and an axial length (AL) of 26 mm or longer were enrolled. Interventions: Participants were stratified into 3 groups based on the AL (stratum 1, 26 mm ≤ AL <28 mm; stratum 2, 28 mm ≤ AL <30mm; stratum 3, AL ≥30 mm), and further randomly assigned to the CTR group (a C-loop IOL combined with a CTR) or the control group (only a C-loop IOL) within each stratum. Main Outcomes and Measures: IOL decentration at 3 months after cataract surgery was evaluated using anterior segment optical coherence tomography. Results: A total of 186 eyes of 186 participants (mean [SD] age, 57.3 [10.9] years; 118 female [63.4%]) were randomized into the CTR group (93 [50%]) or control group (93 [50%]), with 87 eyes (93.6%) and 92 eyes (98.9%) completing follow-up at 3 months, respectively. The CTR group showed smaller IOL decentration (0.19 mm vs 0.23 mm; difference, -0.04 mm; 95% CI, -0.07 to -0.01 mm; P = .02) and tilt at 3 months, and lower proportions of clinically significant IOL decentration (≥0.4 mm) and tilt (≥7°) at 3 months compared with the control group. Similar results were only found in eyes with an AL of 30 mm or longer (IOL decentration: 0.20 mm vs 0.28 mm; difference, -0.08 mm; 95% CI, -0.14 to -0.02 mm; P = .01). Additionally, the CTR group showed a smaller change in IOL decentration from 1 week to 3 months, higher prediction accuracy, and better visual quality and patient satisfaction in this stratum. No differences were observed between the CTR and control groups in eyes with an AL less than 30 mm. Conclusions and Relevance: CTR implantation reduced C-loop IOL decentration and tilt, increased position stability, and improved visual quality in eyes with an AL of 30 mm or longer. These findings support use of CTR implantation in eyes with an AL of 30 mm or longer and implanted with C-loop IOLs. Trial Registration: ClinicalTrials.gov Identifier: NCT05161520.
Subject(s)
Artificial Lens Implant Migration , Lenses, Intraocular , Phacoemulsification , Visual Acuity , Humans , Female , Male , Middle Aged , Visual Acuity/physiology , Aged , Artificial Lens Implant Migration/physiopathology , Artificial Lens Implant Migration/surgery , Lens Implantation, Intraocular , Myopia, Degenerative/physiopathology , Myopia, Degenerative/surgery , Prostheses and Implants , Prospective Studies , Refraction, Ocular/physiology , Follow-Up Studies , Tomography, Optical Coherence , Lens Capsule, Crystalline/surgery , Prosthesis ImplantationABSTRACT
PURPOSE: To investigate the relationship between effective lens position (ELP) and patient characteristics, and to further develop a new intraocular lens (IOL) calculation formula for cataract patients with previous pars plana vitrectomy (PPV). DESIGN: Cross-sectional study. METHODS: A total of 2793 age-related cataract patients (group 1) and 915 post-PPV cataract patients (group 2) who underwent phacoemulsification with IOL implantation were included. The ELP of 2 groups was compared and the association between ELP and patient characteristics was further evaluated using standardized multivariate regression coefficients. An ensemble artificial intelligence-based ELP prediction model was developed using a training set of 810 vitrectomized eyes, and a thick-lens IOL formula (LISA-PPV) was constructed and compared with 7 existing formulas on an external multi-center testing set of 105 eyes. RESULTS: Compared to eyes with age-related cataract, vitrectomized eyes showed a similar ELP distribution (P = .19), but different standardized coefficients of preoperative biometry for ELP. The standardized coefficients also varied with the type of vitreous tamponade, history of scleral buckling, and ciliary sulcus IOL implantation. The LISA-PPV formula showed the lowest mean and median absolute prediction error (MAE: 0.63 D; MedAE: 0.44 D), and the highest percentages of eyes within ±0.5 D of prediction error (57.14%) in the testing dataset. CONCLUSIONS: The ELP prediction required optimization specifically for vitrectomized eyes based on their biometric and surgical characteristics. The LISA-PPV formula is a useful and accurate tool for determining IOL power in cataract patients with previous PPV (available at http://ppv-iolcalculator.com/).
Subject(s)
Artificial Intelligence , Biometry , Lens Implantation, Intraocular , Lenses, Intraocular , Optics and Photonics , Phacoemulsification , Vitrectomy , Humans , Cross-Sectional Studies , Male , Female , Aged , Vitrectomy/methods , Biometry/methods , Middle Aged , Visual Acuity/physiology , Aged, 80 and over , Refraction, Ocular/physiology , Cataract/physiopathology , Cataract/complications , Retrospective StudiesABSTRACT
BACKGROUND/AIMS: Quantity of cataract surgery has long been an important public health indicator to assess health accessibility, however the quality of care has been less investigated. We aimed to summarise the up-to-date evidences to assess the real-world visual outcomes after cataract surgery in different settings. METHODS: A systematic review was undertaken in October 2021. Population-based cross-sectional and longitudinal studies reporting vision-related outcomes after cataract surgery published from 2006 onward were included. A meta-analysis was not planned. RESULTS: Twenty-six cross-sectional studies from low-income and middle-income countries (LMICs) and five cross-sectional studies from high-income countries (HICs) were included. The proportions of participants with postoperative presenting visual acuity (VA) ≥0.32 (20/60) were all over 70% in all HICS studies, but mostly below 70% in LMICS studies, ranging from 29.9% to 80.5%. Significant difference in postoperative VA was also observed within countries. The leading causes for postoperative visual impairment (defined mostly as presenting VA <20/60) mainly included refractive error, ocular comorbidities and surgical complications including posterior capsule opacification, except for one study in Nigeria wherein the leading cause was aphakia. Only four population-based cohort studies were included with 5-20 years of follow-up time, generally demonstrating no significant changes in postoperative visual outcomes during the follow-up. CONCLUSIONS: We observed large inequality in the visual outcomes and principal causes of visual impairment after cataract surgery among different countries and regions. Structured quality control and enhancement programmes are needed to improve the outcomes of cataract surgery and reduce inequality.
Subject(s)
Cataract Extraction , Cataract , Humans , Lens Implantation, Intraocular , Cross-Sectional Studies , Cataract/epidemiology , Vision DisordersABSTRACT
PURPOSE: To investigate the association between exogenous hormone use and the risk of cataract surgery among working-aged Australian women. METHODS: A total of 91 760 female participants aged 45-65 years and without prior history of cataract surgery were prospectively enrolled between January 2006 and December 2009 in New South Wales (NSW), Australia. A baseline self-reported questionnaire was used to collect information on participant demographic, socio-economic, lifestyle characteristics, medical history as well as the use of hormonal contraception and hormone replacement therapy (HRT). Cataract surgery for these participants during 2006-2019 was determined according to the Medicare Benefits Schedule database. Cox regression was used to assess the association between exogenous hormone use and incident cataract surgery during the follow-up. RESULTS: During a mean follow-up of 11.3 years, 10 444 participants underwent cataract surgery with a corresponding incidence of 11.4% (10 444/91 760). Compared with never users, ever and current users of HRT had a 22% and 14% increased risk of cataract surgery, respectively. A dose-response with longer HRT use resulting in a larger increase in cataract surgery risk was observed (p for trend <0.001). Among participants never used HRT, hormonal contraception had a protective effect against incident cataract surgery (hazards ratio: 0.87; 95% confidence interval: 0.80-0.94). CONCLUSIONS: Use of HRT significantly increased the risk of cataract surgery, and hormonal contraception use had a protective effect on cataract surgery among HRT non-users. Further studies assessing the effect of different hormone types and doses are needed.
Subject(s)
Cataract , National Health Programs , Aged , Humans , Female , Australia , Cataract/epidemiology , Cataract/etiology , Hormone Replacement Therapy/adverse effects , Hormones , Risk FactorsABSTRACT
Purpose: The purpose of this study was to compare total keratometry (TK) and posterior keratometry (PK) obtained by two swept-source optical biometers (IOLMaster 700 and CASIA2) and one Scheimpflug-based topography (Pentacam AXL). Methods: The TK and PK in cataract surgery candidates obtained by IOLMaster 700, CASIA2, and Pentacam AXL were compared. Intraclass correlation coefficients (ICCs), limit of agreement, and Bland-Altman plots were used to assess the agreement. Results: One hundred two patients with a mean age of 68.21 ± 8.70 years were included. There were significant differences among IOLMaster 700, CASIA2, and Pentacam AXL in the mean TK (TKm) (44.23 ± 1.59 diopters [D] vs. 43.25 ± 1.53 D vs. 43.94 ± 1.68 D; all P < 0.001), mean PK (PKm; -5.90 ± 0.24 D vs. -6.25 ± 0.25 D vs. -6.37 ± 0.26 D; all P < 0.001) and TK-J0 (-0.34 ± 0.65 D vs. -0.23 ± 0.53 D vs. -0.12 ± 0.62 D; all P < 0.001). We also observed significant differences in PK-J45 between IOLMaster 700 and Pentacam AXL as well as between CASIA2 and Pentacam AXL (both P < 0.001). There was a good agreement in TKm, TK-J0, TK-J45, and PK-J0 (ICC = 0.887, 0.880, 0.751, and 0.807, respectively), a moderate agreement in PK-J45 (ICC = 0.626), and a poor agreement in PKm (ICC = 0.498) among these 3 biometers. Conclusions: TK, PK, and the corresponding astigmatism obtained by IOLMaster 700, CASIA2, and Pentacam AXL showed significant differences, and could not be used interchangeably. Translational Relevance: Our study may help to guide preoperative keratometry measurement for intraocular lens (IOL) power calculation and astigmatism evaluation for patients with cataract.
Subject(s)
Astigmatism , Cataract , Humans , Middle Aged , Aged , Biometry , Prospective Studies , CorneaABSTRACT
PURPOSE: To explore the risk factors and construct nomogram models to predict the risks of clinically significant intraocular lens (IOL) tilt and decentration after cataract surgery in patients with age-related cataract. SETTING: Zhongshan Ophthalmic Center, Guangzhou, China. DESIGN: Prospective cohort study. METHODS: 207 patients (207 eyes) who underwent phacoemulsification combined with IOL implantation were enrolled in the study. Casia2 was used to measure the tilt and decentration of crystalline lenses and IOLs before and 3 months after surgery. Univariate and multivariate logistic regression analyses were used to determine the risk factors of clinically significant IOL tilt and decentration, and nomogram prediction models were constructed according to the results of the multivariate logistic regression analysis. RESULTS: Two hundred and seven patients were included in analysis. 24 eyes (11.59%) and 16 eyes (7.73%) had clinically significant IOL tilt and decentration at 3 months after cataract surgery. Multivariate logistic regression analysis revealed that preoperative crystalline lens tilt and decentration were the risk factors for clinically significant IOL tilt (odds ratio [OR], 3.519, P < .001) and decentration (OR, 410.22, P = .001), respectively. Axial length was another association factor for clinically significant IOL decentration (OR, 2.155, P = .019). The risk models demonstrated good calibrations and discriminations for the predictions of clinically significant IOL tilt (receiver operating characteristic [ROC] area = 0.833, cutoff value = 6.5) and decentration (ROC area = 0.757, cutoff value = 0.08). CONCLUSIONS: The good performances of our models suggested that they may be useful risk prediction tools for postoperative IOL tilt and decentration. The measurement of preoperative crystalline lens tilt and decentration should be one of the routine examinations before cataract surgery, especially for toric and multifocal IOLs.
Subject(s)
Cataract Extraction , Cataract , Lenses, Intraocular , Phacoemulsification , Humans , Lens Implantation, Intraocular , Prospective Studies , Cataract Extraction/adverse effects , Cataract/etiologyABSTRACT
PURPOSE: To investigate the proportion of patients with predicted refractive astigmatism (PRA) of 0.75 diopters (D) or greater and associated risk factors among cataract surgery candidates with low corneal astigmatism. METHODS: A retrospective cross-sectional study was conducted in Zhongshan Ophthalmic Center, Guangzhou, China. Patients with cataract who had preoperative simulated keratometric astigmatism of less than 0.75 D were recruited. The PRA was calculated by Barrett toric calculator using posterior corneal astigmatism (PCA) measured by the IOLMaster 700 (Carl Zeiss Meditec AG) and corneal surgically induced astigmatism (SIA). Two corneal incision locations (temporal [0°/180°], 135° incision) and varying magnitudes (0.10 to 0.60 D) were considered for SIA. Multiple logistic regression analysis was used to explore risk factors associated with PRA of 0.75 D or greater and build predictive model. Sensitivity analysis was performed using PRA threshold of 0.50 D. RESULTS: A total of 1,750 eyes from 1,750 patients were included (mean age: 60.14 ± 13.24 years, 42.91% male, 1,010 right eyes and 740 left eyes). The 135° incision (odds ratio [OR]: 17.86) and against-the-rule (ATR) astigmatism (OR: 37.55) are the major risk factors for PRA of 0.75 D or greater. Higher simulated keratometric astigmatism (OR: 2.03), larger PCA (OR: 1.64), and surgically induced astigmatism (OR: 1.29) also significantly increased the risk of PRA of 0.75 D or greater. Nomogram model were constructed with an area under curve of 0.90. CONCLUSIONS: For patients with corneal astigmatism of less than 0.75 D, temporal incision and measured PCA is preferred. Those patients with ATR astigmatism should be considered for astigmatism correction when using a 135° incision. [J Refract Surg. 2023;39(12):850-855.].
Subject(s)
Astigmatism , Cataract , Corneal Diseases , Phacoemulsification , Surgical Wound , Humans , Male , Middle Aged , Aged , Female , Astigmatism/surgery , Lens Implantation, Intraocular/adverse effects , Retrospective Studies , Cross-Sectional Studies , Phacoemulsification/adverse effects , Cornea/surgery , Cataract/complications , Corneal Diseases/etiology , Corneal TopographyABSTRACT
Purpose: The underlying mechanism of congenital cataracts caused by deficiency or mutation of junctional adhesion molecule C (JAM-C) gene remains unclear. Our study aims to elucidate the abnormal developmental process in Jamc-/- lenses and reveal the genes related to lens development that JAM-C may regulate. Methods: Jamc knockout (Jamc-/-) mouse embryos and pups were generated for in vivo studies. Four key developmental stages from embryonic day (E) 12.5 to postnatal day (P) 0.5 were selected for the following experiments. Hematoxylin and eosin staining was used for histological analysis. The 5-bromo-2'-deoxyuridine (BrdU) incorporation assay and TUNEL staining were performed to label lens epithelial cell (LEC) proliferation and apoptosis, respectively. Immunofluorescence and Western blot were used to analyze the markers of lens epithelium, cell cycle exit, and lens fiber differentiation. Results: JAM-C was expressed throughout the process of lens development. Deletion of Jamc resulted in decreased lens size and disorganized lens fibers, which arose from E16.5 and aggravated gradually. The LECs of Jamc-/- lenses showed decreased quantity and proliferation, accompanied with reduction of key transcription factor, FOXE3. The fibers in Jamc-/- lenses were disorganized. Moreover, Jamc-deficient lens fibers showed significantly altered distribution patterns of Cx46 and Cx50. The marker of fiber homeostasis, γ-crystallin, was also decreased in the inner cortex and core fibers of Jamc-/- lenses. Conclusions: Deletion of JAM-C exhibits malfunction of LEC proliferation and fiber maturation during murine lens development, which may be related to the downregulation of FOXE3 expression and abnormal localization patterns of Cx46 and Cx50.
Subject(s)
Junctional Adhesion Molecule C , Lens, Crystalline , Animals , Mice , Cell Differentiation/physiology , Cell Proliferation , Epithelial Cells/metabolism , Epithelium , Junctional Adhesion Molecule C/metabolism , Lens, Crystalline/metabolism , Mice, KnockoutABSTRACT
PURPOSE: To determine the optimal intraocular lens (IOL) calculation formula for vitrectomized eyes with diverse surgical and biometric characteristics. SETTING: Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. DESIGN: Retrospective consecutive case series study. METHODS: This study included 974 vitrectomized eyes (974 patients) scheduled for phacoemulsification with IOL implantation. 11 formulas were evaluated: Barrett Universal II (BUII), Emmetropia Verifying Optical, Hoffer-QST, Kane, Ladas Super Formula, Pearl-DGS, Radial Basis Function (RBF), Haigis, HofferQ, Holladay1, and SRK/T. Risk factors for prediction error (PE) exceeding 1 diopter (D) were determined using multiple logistic regression. Subgroup analyses were performed based on surgical history and biometric parameters. RESULTS: The risk of hyperopic PE (>1 D) was higher in patients with silicone oil tamponade (odds ratio [OR], 1.82) and longer axial length (AL) (OR, 1.55), while patients with previous scleral buckling (OR, 2.43) or ciliary sulcus IOL implantation (OR, 6.65) were more susceptible to myopic PE (<-1 D). The Kane formula had the highest overall prediction accuracy, and also the best in silicone oil-filled eyes and the flat cornea subgroup. The BUII and RBF displayed the optimal performance in eyes with previous scleral buckle and steep cornea, respectively. In eyes with an AL ≥ 26 mm, the Holladay1 with the nonlinear version of the Wang-Koch AL adjustment (Holladay1-WKn) showed the lowest absolute PE and highest percentage within ± 1.0 D of PE. CONCLUSIONS: The Kane achieved the highest overall prediction accuracy in vitrectomized eyes. The optimal formula for eyes with previous scleral buckle, steep cornea, or long AL was BUII, RBF, and Holladay1-WKn, respectively.
Subject(s)
Cataract , Lenses, Intraocular , Phacoemulsification , Humans , Refraction, Ocular , Lens Implantation, Intraocular , Vitrectomy , Retrospective Studies , Silicone Oils , Axial Length, Eye , Biometry , Optics and PhotonicsABSTRACT
PURPOSE: To investigate the effect of different myopia severity on the health-related quality of life (QOL) in both children and their parents. METHODS: Cross-sectional study from October to November, 2021. Age and sex-matched children with binocular emmetropia (-0.5D < spherical equivalence [SE] < 0.5D), low myopia (-5.0D < SE ≤ -0.5D), and high myopia (SE ≤ -5.0D), as well as their parents, were enrolled. All children underwent ocular examinations. The Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales, Version 4 (child-report, 23 items) and the PedsQL Family Impact Module, Version 2 (parent-report, 36 items) was used for QOL assessment of the children and their parents, respectively. RESULTS: Forty-one, 48 and 45 age- and sex-matched children with their accompanying parents were included in the emmetropia, low myopia and high myopia group, respectively. Parents in the three groups also did not differ in age, sex, or education level. The median total QOL scores were comparable for emmetropic and low myopic children (96.74 [IQR: 93.48-97.83] vs. 96.74 [IQR: 94.57-98.37]) but were significantly lower for high myopic children (88.04 [IQR: 82.61-92.39], both p < .001). A decreasing trend was observed in the median total QOL for parents in the emmetropia (96.53, IQR: 86.81-100), low myopia (82.30, IQR: 70.83-97.22), and high myopia group (70.83, IQR: 60.42-84.03) (p for trend <.001). The effect of per myopic diopter change on QOL was larger in parents than children (coefficient: 1.48 (95%CI: 1.19-1.78) vs. 2.58 [95%CI: 1.83-3.32]), and parents with higher educational level appeared to have more reduction in QOL (p = .008). CONCLUSIONS: More severe myopia resulted in a larger QOL decrease in both children and parents. Significantly reduced QOL were identified in children with high myopia and parents of children with any myopia.
Subject(s)
Myopia , Quality of Life , Humans , Cross-Sectional Studies , Parents , Myopia/diagnosis , Refraction, Ocular , Surveys and QuestionnairesABSTRACT
Purpose: To identify risk factors of ocular anterior segment measurement error by the IOLMaster 700 in eyes implanted with an implantable Collamer lens (ICL). Methods: In total, 152 patients with clear lens (152 eyes, group 1) and another 32 cataract patients (57 eyes, group 2) who underwent ICL implantation were included, and the presence of measurement error by the IOLMaster 700 was determined based on B-scan images. The risk factors for measurement error were evaluated by logistic regression, and the optimal threshold was determined using receiver operating characteristic analysis. Results: The ICL was misidentified as the anterior surface of the crystalline lens in 51.97% of eyes (79/152) in group 1 and 80.70% of eyes (46/57) in group 2. For every 100-µm decrease in the vault height, a 3.57- and 5.78-fold increase in the risk of measurement error was observed in group 1 and group 2, respectively. We identified an optimal threshold of the vault height at 389.47 µm for predicting biometric measurement error in eyes implanted with ICL, which showed an area under the curve of 0.93 (95% confidence interval, 0.90-0.97), a sensitivity of 0.87, and a specificity of 0.86. Conclusions: Patients with ICL implantation, particularly those with a vault height less than 389.47 µm, are at a greater risk of anterior segment biometric measurement error by the IOLMaster 700. Translational Relevance: The threshold of vault height can help to identify high-risk patients and further optimize biometric measurement.
Subject(s)
Cataract , Phakic Intraocular Lenses , Humans , EyeABSTRACT
PURPOSE: Visual impairment from cataracts is closely associated with low income, but trial evidence regarding the impact of surgery on income is lacking. We investigated whether cataract surgery could increase personal income. DESIGN: A 2-arm, parallel-group, open-label, randomized controlled trial (ClinicalTrials.gov, NCT03020056). METHODS: Persons aged 50 years or older in rural Guangdong, China, with best-corrected visual acuity <6/19 in both eyes due to cataracts were randomly assigned (1:1) to receive surgery within 4 weeks (intervention group), or 1 year later (control group). All participants were interviewed at baseline and end-line regarding demographic characteristics, income, and quality of life. RESULTS: Among the 292 eligible persons (5.40%, mean age = 74.0 y, 61.0% women) randomly assigned to intervention (n = 146) or control (n = 146) groups, 12 participants (8.22%) in the intervention group and 1 (0.68%) in the control did not receive the allocated intervention. By study closeout, 18 participants (6.16%) were lost to follow-up. The mean 1-year income increase of the intervention group ($2469-$3588; change = $1119) was significantly larger than that of the controls ($2258-$2052; change = $-206), a between-group difference of $1325 (relative increase = 54.0%; 95% CI = $739 to $1911; P < 0.001). In multivariable modeling, intervention group membership was associated with greater income increase (ß = 1143.2; 95% CI = 582.0 to 1704.3; P < 0.001). Greater improvement in best-corrected visual acuity was associated with income increase in univariable modeling (ß = 1626.9; 95% CI = 1083.6 to 2170.1; P < 0.001). CONCLUSIONS: Cataract surgery substantially increases personal income in rural China, offering a strategy for poverty alleviation. The strong association between increased income and change in visual acuity enhances the biological plausibility of the result.
Subject(s)
Cataract Extraction , Cataract , Humans , Female , Aged , Male , Quality of Life , Cataract/complications , Visual Acuity , China/epidemiologyABSTRACT
PURPOSE: Autophagy plays a crucial role in intracellular quality control of crystalline lens and AMPK has regulatory effect on autophagy. However, whether AMPK regulated autophagy is involved in diabetic cataract (DC) progression remains unknown. This study aims to investigate the AMPK-FOXO3 and AMPK-TFEB induced autophagy activity in DC patients. MATERIALS AND METHODS: First, anterior capsule specimens from DC and age-related cataract (ARC) patients were obtained to compare the expression difference of autophagy-related genes. The phosphorylation levels of AMPK, AKT, and mTOR and the expression of FOXO3 and TFEB were measured. Then, human lens epithelial cells (LECs, SRA 01/04) were cultured with 30 mM or 5.5 mM glucose, and AMPK activator (AICAR) and inhibitor (Compound C) were applied to further investigate the regulatory role of AMPK on autophagy. RESULTS: Compared with ARC patients, the expression of autophagy-related genes ATG5, FYCO1, ATG8, ATG12, Beclin1, and ULK1 in anterior capsules LECs of DC patients were significantly down-regulated. Meanwhile, AMPK and AMPK-dependent transcription factors, FOXO3 and TFEB were also inhibited. Similar results were found in high glucose (HG) treated SRA 01/04 model. Notably, this down-regulation of autophagy activity was rescued by AICAR in vitro, which was manifested by inhibition of AKT and mTOR phosphorylation and up-regulation of FOXO3, TFEB, Beclin1 and LC3B-II expression. CONCLUSIONS: Down-regulation of AMPK-FOXO3 and AMPK-TFEB induced autophagy activity was found in both LECs of anterior capsule from DC patients and SRA 01/04 cells under HG condition, which may be the underlying mechanism of DC formation. Thus, targeting AMPK-induced autophagy may be a potential therapeutic approach for diabetic cataract.