Effect of spectacle correction on hyperopic children.

Background: Hyperopia is a significant refractive error in children, often leading to vision impairment. This study aimed to investigate whether partial or full spectacle correction is benefit for hyperopia in preschool-aged children. Methods: A retrospective study was conducted on hyperopic children visited to teaching medical center outpatient clinic between October 2011 and October 2018, and were categorized into three groups: full correction, overcorrection, and undercorrection. The study was approved by the institutional ethical committee of Tri-Service General Hospital. Results: Following a minimum of one-year follow-up period, no statistically significant differences were observed in best-corrected visual acuity (BCVA) among children receiving full, over, or under spectacle correction. Notably, the overcorrection group exhibited a significant reduction in spherical equivalent (SE) compared to both the full and under correction groups, indicating a better SE with spectacle overcorrection. Conclusions: Spectacle overcorrection may offer potential benefits for enhancing SE in preschool children with hyperopia. Nevertheless, further investigation through randomized controlled trials is warranted to establish the validity of this approach and its impact on visual outcomes in this hyperopic pediatric population.

Chorioretinal Folds in the Trabeculectomized Eye with Normal Intraocular Pressure after Phacoemulsification.

Background and Objectives: This case report discusses possible causes of chorioretinal fold (CRF) formation. Materials and Methods: A case report. Results: A 48-year-old man presented with a history of high myopia and primary open-angle glaucoma in both eyes. He underwent a trabeculectomy followed by phacoemulsification in both eyes. Two months later, he complained of blurred vision in the right eye. The intraocular pressure (IOP) was 17 mmHg in the left eye and 9 mmHg in the right eye. Refraction showed a hyperopic shift in both eyes. Slit-lamp examination showed a deep anterior chamber without cells and a well-functional bleb without leakage. Fundus examination revealed CRFs in the macula of the right eye. No papilledema, choroidal lesions, or other retinal lesions were found. Wrinkling of CRFs at the macula, an increase in central foveal thickness, and a fluid cleft were demonstrated by spectral-domain optical coherence tomography. After using steroid eye drops, the IOP in the right eye and refraction in both eyes recovered to the baseline level. Visual acuity improved in both eyes. Conclusions: CRFs in trabeculectomized eyes with normal IOP after phacoemulsification have not been reported. This case demonstrated that the trabeculectomized eye remains at risk of CRF formation, even if the IOP is normal without hypotony. The importance of a detailed fundus examination in patients with unexplained blurred vision may be necessary after having undergone these procedures. The early recognition of the cause of visual loss may facilitate immediate treatment and may avoid irreversible changes with permanent visual loss.

A Pulmonary Pleomorphic Carcinoma Patient with Exudative Retinal Detachment Secondary to Choroid Metastasis as Initial Presentation-A Case Report.

Choroid metastasis is the initial presentation of pleomorphic carcinoma (PC) of the lung. PC is classified as poorly differentiated non-small cell lung carcinoma. It has a tendency to metastasize early and has a poor response to chemotherapy, which often results in poor prognosis. We report the case of a 63-year-old woman with a one-month history of deteriorating vision in the left eye. Fundus examination, fluorescein angiography, indocyanine green angiography, and B-scan sonography demonstrated choroidal metastasis of the left eye. Positron emission tomography/computed tomography (PET/CT) revealed a tumor with increased uptake in the left upper lung. Subsequent bronchoscopic biopsy confirmed a pleomorphic carcinoma of the lungs. Choroid metastasis as an initial presentation of PC in the lung is rare. Usually, it represents the late course of disseminated disease with hematogenous spread. Prompt diagnosis is imperative for patients to immediately initiate treatment.

AR12286 Alleviates TGF-ß-Related Myofibroblast Transdifferentiation and Reduces Fibrosis after Glaucoma Filtration Surgery.

Scar formation can cause the failure of glaucoma filtration surgery. We investigated the effect of AR12286, a selective Rho-associated kinase inhibitor, on myofibroblast transdifferentiation and intraocular pressure assessment in rabbit glaucoma filtration surgery models. Cell migration and collagen contraction were used to demonstrate the functionality of AR12286-modulated human conjunctival fibroblasts (HConFs). Polymerase chain reaction quantitative analysis was used to determine the effect of AR12286 on the production of collagen Type 1A1 and fibronectin 1. Cell migration and collagen contraction in HConFs were activated by TGF-ß1. However, compared with the control group, rabbit models treated with AR12286 exhibited higher reduction in intraocular pressure after filtration surgery, and decreased collagen levels at the wound site in vivo. Therefore, increased α-SMA expression in HConFs induced by TGF-ß1 could be inhibited by AR12286, and the production of Type 1A1 collagen and fibronectin 1 in TGF-ß1-treated HConFs was inhibited by AR12286. Overall, the stimulation of HConFs by TGF-ß1 was alleviated by AR12286, and this effect was mediated by the downregulation of TGF-ß receptor-related SMAD signaling pathways. In vivo results indicated that AR12286 thus improves the outcome of filtration surgery as a result of its antifibrotic action in the bleb tissue because AR12286 inhibited the TGF-ß receptor-related signaling pathway, suppressing several downstream reactions in myofibroblast transdifferentiation.

Glucosamine-Induced Autophagy through AMPK⁻mTOR Pathway Attenuates Lipofuscin-Like Autofluorescence in Human Retinal Pigment Epithelial Cells In Vitro.

Age-related macular degeneration (AMD) is a vision-threatening age-associated disease. The retinal pigment epithelial (RPE) cells phagocytose and digest photoreceptor outer segment (POS). Incomplete digestion of POS leads to lipofuscin accumulation, which contributes to the pathology of the AMD. Autophagy could help reduce the amount of lipofuscin accumulation. In the present study, we evaluated the effects of glucosamine (GlcN), a natural supplement, on the induction of autophagy and POS-derived lipofuscin-like autofluorescence (LLAF) in ARPE-19 cells in vitro, and investigated the potential molecular pathway involved. Our results revealed that GlcN had no effect on phagocytosis of POS at the lower doses. GlcN treatment induced autophagy in cells. GlcN decreased the LLAF in native POS-treated cells, whereas malondialdehyde or 4-hydroxynonenal-modified POS attenuated this effect. 3-Methyladenine inhibited GlcN-induced autophagy and attenuated the effect of GlcN on the decrease of the native POS-derived LLAF. Furthermore, GlcN induced the phosphorylation of AMP-activated protein kinase (AMPK) and inhibited the phosphorylation of mammalian target of rapamycin (mTOR), whereas Compound C inhibited these effects of GlcN. Altogether, these results suggest that GlcN decreased the native POS-derived LLAF through induction of autophagy, at least in part, by the AMPK⁻mTOR pathway. This mechanism has potential for the preventive treatment of lipofuscin-related retinal degeneration such as AMD.

Deep Learning Evaluation of Glaucoma Detection Using Fundus Photographs in Highly Myopic Populations.

OBJECTIVES: This study aimed to use deep learning to identify glaucoma and normal eyes in groups with high myopia using fundus photographs. METHODS: Patients who visited Tri-Services General Hospital from 1 November 2018 to 31 October 2022 were retrospectively reviewed. Patients with high myopia (spherical equivalent refraction of ≤-6.0 D) were included in the current analysis. Meanwhile, patients with pathological myopia were excluded. The participants were then divided into the high myopia group and high myopia glaucoma group. We used two classification models with the convolutional block attention module (CBAM), an attention mechanism module that enhances the performance of convolutional neural networks (CNNs), to investigate glaucoma cases. The learning data of this experiment were evaluated through fivefold cross-validation. The images were categorized into training, validation, and test sets in a ratio of 6:2:2. Grad-CAM visual visualization improved the interpretability of the CNN results. The performance indicators for evaluating the model include the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. RESULTS: A total of 3088 fundus photographs were used for the deep-learning model, including 1540 and 1548 fundus photographs for the high myopia glaucoma and high myopia groups, respectively. The average refractive power of the high myopia glaucoma group and the high myopia group were -8.83 ± 2.9 D and -8.73 ± 2.6 D, respectively (p = 0.30). Based on a fivefold cross-validation assessment, the ConvNeXt_Base+CBAM architecture had the best performance, with an AUC of 0.894, accuracy of 82.16%, sensitivity of 81.04%, specificity of 83.27%, and F1 score of 81.92%. CONCLUSIONS: Glaucoma in individuals with high myopia was identified from their fundus photographs.

Increased Risk of Glaucoma in Patients with Sjögren's Syndrome: A Nationwide Population-Based Cohort Study.

PURPOSE: The risk of glaucoma in patients suffering from Sjögren's syndrome has not been elucidated. We aimed for evaluating the absolute incidence as well as the relative risk of glaucoma in patients with SS at the level of the whole country population. METHODS: We conducted a retrospective cohort study using a national health insurance database in Taiwan from 2000 to 2013. We used International Classification of Diseases, Ninth Revision, to categorise medical conditions for study group and comparison group. We used Cox proportional hazard regression analysis to determine adjusted hazard ratios (aHRs) of glaucoma between study and comparison group after adjusting for sex, age, and comorbidities. RESULTS: Among 17,398 patients with primary Sjögren's syndrome, 133 patients were diagnosis with glaucoma during follow-up. Of the 69,592 non-primary Sjögren's syndrome patients, 429 patients developed glaucoma. Glaucoma risk was elevated in patients with primary Sjögren's syndrome than in the non-Sjögren's syndrome group (adjusted hazard ratio [HR] 2.274, 95% in the confidence interval [95% CI] 1.847-2.800; P < .001). CONCLUSIONS: The risk of glaucoma among the population having Sjögren's syndrome was higher than those did not have Sjögren's syndrome. It indicated the necessity of regular examination for glaucoma in patients with Sjögren's syndrome.

The Association between Diabetic Retinopathy and Macular Degeneration: A Nationwide Population-Based Study.

OBJECTIVE: Age-related macular degeneration (AMD), particularly its exudative form, is a primary cause of vision impairment in older adults. As diabetes becomes increasingly prevalent in aging, it is crucial to explore the potential relationship between diabetic retinopathy (DR) and AMD. This study aimed to assess the risk of developing overall, non-exudative, and exudative AMD in individuals with DR compared to those without retinopathy (non-DR) based on a nationwide population study in Taiwan. METHODS: A retrospective cohort study was conducted using the Taiwan National Health Insurance Database (NHIRD) (2000-2013). A total of 3413 patients were placed in the study group (DR) and 13,652 in the control group (non-DR) for analysis. Kaplan-Meier analysis and the Cox proportional hazards model were used to calculate the hazard ratios (HRs) and adjusted hazard ratios (aHRs) for the development of AMD, adjusting for confounding factors, such as age, sex, and comorbid conditions. RESULTS: Kaplan-Meier survival analysis indicated a significantly higher cumulative incidence of AMD in the DR group compared to the non-DR group (log-rank test, p < 0.001). Adjusted analyses revealed that individuals with DR faced a greater risk of overall AMD, with an aHR of 3.50 (95% CI = 3.10-3.95). For senile (unspecified) AMD, the aHR was 3.45 (95% CI = 3.04-3.92); for non-exudative senile AMD, it was 2.92 (95% CI = 2.08-4.09); and for exudative AMD, the aHR was 3.92 (95% CI = 2.51-6.14). CONCLUSION: DR is a significant risk factor for both overall, senile, exudative, and non-exudative AMD, even after adjusting for demographic and comorbid conditions. DR patients tend to have a higher prevalence of vascular comorbidities; however, our findings indicate that the ocular pathologies inherent to DR might have a more significant impact on the progression to AMD. Early detection and appropriate treatment of AMD is critically important among DR patients.

Use of corticosteroids in non-infectious uveitis - expert consensus in Taiwan.

PURPOSE: To offer consensus on the utilization of corticosteroids (CS) for treating non-infectious uveitis in the context of clinical practice in Taiwan. This entails examining the different administration methods, their advantages and disadvantages, and considering alternative treatments according to the prevailing evidence and health policies. METHODS: Ten ophthalmologists and one rheumatologist convened on December 11, 2022, to review and discuss literature on the topic. The databases explored were the Central Cochrane library, EMBASE, Medline, PUBMED, and Web of Science using relevant keywords. The search spanned from January 1996 to June 2023. After the initial results of the literature review were presented, open voting determined the final statements, with a statement being accepted if it secured more than 70% agreement. This consensus was then presented at significant meetings for further discussions before the final version was established. RESULTS: A flow chart and nine statements emerged from the deliberations. They address the importance of CS in uveitis management, guidelines for using topical CS, indications for both periocular or intravitreal and systemic therapies, and tapering and discontinuation methods for both topical and systemic CS. CONCLUSION: While CS are a cornerstone for non-infectious uveitis treatment, their administration requires careful consideration, depending on the clinical situation and the specific type of uveitis. The consensus generated from this article provides a guideline for practitioners in Taiwan, taking into account local health policies and the latest research on the subject. It emphasizes the significance of strategic tapering, the potential for alternative therapies, and the importance of patient-centric care.

Anterior chamber paracentesis and pH values in patients with acute primary angle closure.

BACKGROUND: To assess the efficacy and safety of anterior chamber paracentesis (ACP) and the changes in pH values in eyes with acute primary angle closure (APAC). METHODS: This retrospective case-control study involved 22 patients with APAC who underwent ACP (study group) and 21 patients with APAC who did not undergo ACP (control group). Intraocular pressure (IOP) and visual acuity were measured before treatment and 15 min and 24 h after treatment in both groups. The pH of aqueous humor was measured immediately after ACP in the study group. RESULTS: A total of 43 eyes in 43 patients were reviewed. The IOP 15 min after ACP (23.3 ± 9.6 mmHg) and 24 h after ACP (21.6 ± 12.0 mmHg) were significantly lower than that before ACP (58.6 ± 12.9 mmHg). The IOP 15 min after ACP was significantly lower than the IOP 15 min after conventional treatment (55.4 ± 10.3 mmHg). Visual acuity recovery was achieved earlier after ACP than after conventional treatment. Hyphema after ACP was noted in one eye. The mean pH of the aqueous humor in APAC was 6.99 ± 0.35. The pH of the aqueous humor significantly correlated with the duration of acute IOP elevation and the IOP before ACP. CONCLUSIONS: ACP is an effective and safe procedure. The pH of aqueous humor is lower in eyes with APAC of longer duration and in eyes with higher IOP at presentation.

Impact of Endophthalmitis on the Risk of Acute Myocardial Infarction in Ankylosing Spondylitis Patients: A Population-Based Retrospective Cohort Study.

Many studies have demonstrated an increased cardiovascular (CV) risk in ankylosing spondylitis (AS) patients. Nevertheless, the influence of an endophthalmitis episode toward the future risks of acute myocardial infarction (AMI) in AS patients has been unclear. The objective of this study was to explore the impact of endophthalmitis on AMI risk in this particular patient population by a population-based retrospective cohort study with a follow-up period up to 16 years. Univariate and multivariate Cox regression analyses were used for the risk evaluation and the results were presented as crude and adjusted hazard ratios (HRs). Overall, we enrolled 557 AS patients with endophthalmitis as the study cohort and selected another 2228 matched AS patients without endophthalmitis as the comparison cohort. Comparing the comparison cohort, the study cohort showed a significantly higher overall AMI incidence rate with an adjusted HR of 1.631 (p < 0.001). In conclusion, endophthalmitis increased the risk of AMI in AS patients after adjusting for possible clinical confounders. Special attention and work-up are required for physicians when encountering a history of endophthalmitis in these special patient populations, especially when they are comorbid with other potential CV risk factors.

MicroRNA-4516 suppresses proliferative vitreoretinopathy development via negatively regulating OTX1.

Proliferative vitreoretinopathy (PVR) progression is associated with TGF-ß2-induced epithelial-mesenchymal transition (EMT) in retinal pigment epithelial (RPE) cells. In cancer cells, miR-4516 downregulates orthodenticle homeobox 1 (OTX1)-mediated cell invasion. Moreover, OTX1 is shown to be involved in invasion and EMT. The purpose of this study was to assess whether microRNA (miR-4516) suppresses EMT in RPE cells. EMT features were assessed using Western blotting, immunocytochemical staining, scratch-wound healing, modified Boyden chamber assay, and collagen gel contraction assay. For in vivo testing, a rabbit model was used, which involved induction of PVR by injection of transfected spontaneously arising RPE (ARPE) cells into the vitreous chamber. The putative target of miR-4516 was identified by luciferase reporter assay. Results showed that TGF-ß2-induced transdifferentiation and migration of RPE cells was inhibited by miR-4516 delivery. Overexpression of miR-4516 led to upregulation of zonula occludens-1, downregulation of α-smooth muscle actin and vimentin, and cell contractility-all EMT features-in the TGF-ß2-treated ARPE-19 cells. MiR-4516 regulated OTX1 expression negatively by binding to its 3'-UTR. TGF-ß2-induced phosphorylated ERK was inhibited in miR-4516-overexpressing ARPE-19 cells. MiR-4516 suppressed experimental PVR in vitro and in vivo. In conclusion, the overexpression of miR-4516 suppresses TGF-ß2-induced EMT in a PVR model, and its role in PVR depends on OTX1/ERK. Further research is needed to develop a feasible treatment method to prevent and treat PVR.

Increased Risk of Acute Coronary Syndrome in Ankylosing Spondylitis Patients With Uveitis: A Population-Based Cohort Study.

Background: Uveitis, a sight-threatening ocular inflammatory state, is associated with autoimmune diseases and systemic inflammation. This prolonged systemic inflammation may cause plaque formation in coronary arteries, subsequently resulting in acute coronary syndrome (ACS). Methods: This retrospective, population-based study (15-year period) used the Longitudinal Health Insurance Database based on the National Health Insurance Research Database in Taiwan. Chi-square and Student's t-tests were used to examine differences between the study and comparison cohorts for categorical and continuous variables, respectively. Fine and Gray's competing risk model was used to determine the hazard ratio of the risk of ACS. Furthermore, the cumulative risk of ACS was determined using Kaplan-Meier analysis. Results: A total of 1,111 patients with AS and uveitis were enrolled in this study cohort, and 4,444 patients with AS without uveitis were enrolled in the comparison cohort. After adjustment for age, sex, and comorbidities, patients with AS and uveitis demonstrated an increased risk of ACS compared to those without uveitis (adjusted hazard ratio: 1.675, p<0.001). In addition, Kaplan-Meier analysis revealed that patients with AS and uveitis had a significantly higher risk of ACS than those without uveitis (p<0.001). Age, diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, asthma, and systemic steroids were significant risk factors for ACS. Both anterior uveitis and posterior segment involvement were associated with an increased risk of ACS in patients with AS. All-cause mortality was higher in the uveitis group (9.81%) than in the non-uveitis group (8.10%) (p=0.015). Conclusion: Our analysis revealed that uveitis could potentially be a predictor of ACS in patients with AS. However, further prospective controlled studies are required to assess the association between uveitis and ACS in patients with AS.

Correlation between Endophthalmitis and Stroke Development in Ankylosing Spondylitis Patients: A Population-Based Cohort Study.

BACKGROUND: This cohort study aimed to research the correlation between endophthalmitis and stroke development in ankylosing spondylitis (AS) patients by reviewing National Health Insurance Research Database (NHIRD) data. METHODS: This study obtained data from the NHIRD over a sixteen-year period. The primary outcome was stroke development. We used Fisher's exact test and Pearson's chi-squared test to analyze the variables. We investigated the risk factors for disease development using Cox regression analyses. We compared the cumulative incidence of stroke using Kaplan-Meier analysis. RESULTS: The study cohort included 549 patients with AS and endophthalmitis, while the comparison cohort included 2196 patients with AS but without endophthalmitis. The stroke development was increased in the study cohort (adjusted hazard ratio, 1.873; p ≤ 0.001). The total stroke development in the study cohort and the comparison cohort was 1724.44 per 100,000 person-years and 1085.11 per 100,000 person-years, respectively (adjusted hazard ratio, 1.873; 95% confidence interval, 1.776-2.022; p < 0.001). Our study cohort showed an increased stroke rate. CONCLUSIONS: Our studies showed that endophthalmitis increases the risk of stroke in AS patients and endophthalmitis is an independent risk factor for stroke in AS patients. Nonetheless, advanced studies that thoroughly investigate the correlation between endophthalmitis and stroke in AS patients are needed to validate our findings.

Association Between Endophthalmitis and the Incidence of Acute Coronary Syndrome in Patients With Ankylosing Spondylitis: A Nationwide, Population-Based Cohort Study.

Purpose: Ankylosing spondylitis (AS) is a risk factor for acute coronary syndrome (ACS). However, the influence of infectious insults, such as endophthalmitis, on the risk of ACS among AS patients has not been studied yet. In this study, we aimed to investigate the relationship between endophthalmitis in patients with AS and the incidence of ACS. Methods: This retrospective cohort study extracted medical records from the Taiwan Longitudinal Health Insurance Database (LHID) from January 1, 2000, to December 31, 2015. The primary outcome was the incidence of ACS. Univariate and multivariate Cox regression analyses with and without Fine and Gray's competing risk model and Kaplan-Meier survival curve were used for the analyses. Spearman's rank correlation coefficient was performed for sensitivity analysis. Results: We identified 530 AS patients with endophthalmitis and 2,120 AS patients without endophthalmitis for comparison. The incidence rate of endophthalmitis in our study population was 2.66%. The overall incidence rate of ACS was 1,595.96 per 100,000 person-years in AS patients with endophthalmitis and 953.96 per 100,000 person-years in AS patients without endophthalmitis (adjusted HR = 1.787; 95% CI: 1.594-2.104, p < 0.001). In comparison to those without comorbidities, higher adjusted HRs were found in AS patients with endophthalmitis and comorbidities such as diabetes mellitus, hyperlipidemia, hypertension, cerebrovascular accident, congestive heart failure, chronic obstructive pulmonary disease, asthma, and coronary artery disease. Besides, the age ≥ 60 years revealed a high risk for ACS in AS patients with endophthalmitis. Conclusion: Endophthalmitis was found to be an independent risk factor for ACS in patients with AS. Further clinical studies are required to elucidate the underlying mechanisms and status of systemic inflammation during endophthalmitis.

Diabetic Macular Edema Detection Using End-to-End Deep Fusion Model and Anatomical Landmark Visualization on an Edge Computing Device.

Purpose: Diabetic macular edema (DME) is a common cause of vision impairment and blindness in patients with diabetes. However, vision loss can be prevented by regular eye examinations during primary care. This study aimed to design an artificial intelligence (AI) system to facilitate ophthalmology referrals by physicians. Methods: We developed an end-to-end deep fusion model for DME classification and hard exudate (HE) detection. Based on the architecture of fusion model, we also applied a dual model which included an independent classifier and object detector to perform these two tasks separately. We used 35,001 annotated fundus images from three hospitals between 2007 and 2018 in Taiwan to create a private dataset. The Private dataset, Messidor-1 and Messidor-2 were used to assess the performance of the fusion model for DME classification and HE detection. A second object detector was trained to identify anatomical landmarks (optic disc and macula). We integrated the fusion model and the anatomical landmark detector, and evaluated their performance on an edge device, a device with limited compute resources. Results: For DME classification of our private testing dataset, Messidor-1 and Messidor-2, the area under the receiver operating characteristic curve (AUC) for the fusion model had values of 98.1, 95.2, and 95.8%, the sensitivities were 96.4, 88.7, and 87.4%, the specificities were 90.1, 90.2, and 90.2%, and the accuracies were 90.8, 90.0, and 89.9%, respectively. In addition, the AUC was not significantly different for the fusion and dual models for the three datasets (p = 0.743, 0.942, and 0.114, respectively). For HE detection, the fusion model achieved a sensitivity of 79.5%, a specificity of 87.7%, and an accuracy of 86.3% using our private testing dataset. The sensitivity of the fusion model was higher than that of the dual model (p = 0.048). For optic disc and macula detection, the second object detector achieved accuracies of 98.4% (optic disc) and 99.3% (macula). The fusion model and the anatomical landmark detector can be deployed on a portable edge device. Conclusion: This portable AI system exhibited excellent performance for the classification of DME, and the visualization of HE and anatomical locations. It facilitates interpretability and can serve as a clinical reference for physicians. Clinically, this system could be applied to diabetic eye screening to improve the interpretation of fundus imaging in patients with DME.

Uveitis increases the risk of stroke among patients with ankylosing spondylitis: A nationwide population-based longitudinal study.

Ankylosing spondylitis (AS) is known to increase the risk of stroke. Among patients with AS, uveitis is the most common extra-articular manifestation. However, no previous investigations have discussed the association between uveitis and the risk for developing stroke in patients with AS. This retrospective cohort study aimed to explore the relationship between uveitis and the incidence of stroke in patients with AS by obtaining medical records from January 1, 2000, to December 31, 2015, from the National Health Insurance Research Database, according to the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. The primary outcome was the incidence of stroke. Pearson's chi-square test and Fisher's exact test were used to analyze variables. Kaplan-Meier survival curves and univariate and multivariate Cox proportional hazard regression models with and without Fine and Gray's competing risk model were used to analyze data. Total 828 AS patients with uveitis and 3,312 AS patients without uveitis were identified. During the follow-up period, 137 patients in the uveitis group and 344 in the non-uveitis group developed stroke. Uveitis is a significant risk factor for stroke development in patients with AS (adjusted hazard ratio = 1.846, p < 0.001). Age, diabetes mellitus, hyperlipidemia, hypertension, congestive heart failure, chronic obstructive pulmonary disease, asthma, coronary artery disease, and atrial fibrillation were associated with a higher risk of stroke. After subgroup analysis, both anterior uveitis and posterior segment involvement were found to increase the risk of stroke in patients with AS. Uveitis is associated with an increased risk in both ischemic and hemorrhagic strokes in patients with AS. Therefore, when uveitis is identified, clinicians should pay more attention to the cerebrovascular risk in patients with AS, especially in those with underlying comorbidities.

Step-wise diagnostic approach for patients with uveitis - Experts consensus in Taiwan.

Uveitis is a sight-threatening disease that can be associated with many different etiologies. Successful treatment of uveitis relies on accurate diagnosis and prompt efficient therapy. History taking, physical and ocular examinations, systemic evaluations, and response to treatment provide crucial information to differentiate possible etiologies involved in the pathophysiology of intraocular inflammation. This article provides recommendations for a step-wise approach to patients with uveitis in Taiwan based on an expert meeting and consensus. Systemic evaluations for uveitis should be performed step-by-step and include investigation of patients' general systemic conditions, ruling out infectious etiologies, and obtaining evidential biomarkers to diagnose a specific disease entity.

Repression of Smad4 by MicroRNA-1285 moderates TGF-ß-induced epithelial-mesenchymal transition in proliferative vitreoretinopathy.

The purpose of this study was to assess whether microRNA (miR)-1285 can suppress the epithelial-mesenchymal transition (EMT) in retinal pigment epithelial cells. Expression of miR-1285 was evaluated using quantitative real-time polymerase chain reaction (RT-qPCR). The features of EMT were assessed using Western blotting, immunocytochemical staining, scratch wound healing tests, modified Boyden chamber assay, and collagen gel contraction assay. A rabbit model of proliferative vitreoretinopathy (PVR) was used for in vivo testing, which involved the induction of PVR by injection of transfected ARPE cells into the vitreous chamber. Luciferase reporter assay was performed to identify the putative target of miR-1285. The expression of miR-1285 was downregulated in ARPE-19 cells treated with transforming growth factor (TGF)-ß. Overexpression of miR-1285 led to upregulation of zonula occludens-1, downregulation of α-smooth muscle actin and vimentin, cell migration and cell contractility-all EMT features-in the TGF-ß2-treated ARPE-19 cells. The reporter assay indicated that the 3' untranslated region of Smad4 was the direct target of miR1285. PVR progression was alleviated in the miR-1285 transfected rabbits. In conclusion, overexpression of miR-1285 attenuates TGF-ß2-induced EMT in a rabbit model of PVR, and the effect of miR-1285 in PVR is dependent on Smad4. Further research is warranted to develop a feasible therapeutic approach for the prevention and treatment of PVR.

Outcomes of Small Size Ahmed Glaucoma Valve Implantation in Asian Chronic Angle-Closure Glaucoma.

For chronic angle-closure glaucoma (ACG), Ahmed glaucoma valve (AGV) is a useful drainage device for intraocular pressure (IOP) control but there are few reports discussing the outcomes of small size AGV in adult patients. This retrospective study involved 43 Asian adult patients (43 eyes) with chronic ACG. All patients had undergone small size AGV insertion and were divided into anterior chamber (AC) group and posterior chamber (PC) group. In the AC group, tube was inserted through sclerectomy gap into the anterior chamber. In the PC group, tube was inserted into posterior chamber through a needling tract. Outcome measures were intraocular pressure (IOP), visual acuity, number of antiglaucoma medications, survival curve and incidence of complications. In total, 43 eyes of 43 patients, 24 in the AC group and 19 in the PC group, were reviewed. The mean follow-up period was 28.5 months (95% confidence interval: 25.5-31.4). Mean IOP had significantly decreased following AGV insertion. The Kaplan-Meier survival analysis demonstrated a probability of success at 24 months of 67.4% for qualified success and 39.5% for complete success. There were no significant differences between the AC and PC groups in terms of the mean IOP, cumulative probability of success, visual acuity change or antiglaucoma medication change, except IOP at 1-day and 1-month mean IOP. The most common complications noted was hyphema in the PC group. For adult chronic ACG patients, small size AGV insertion could be effective at lowering IOP. Besides, tube insertion into AC with sclerectomy may prevent the hypertensive phase in the early postoperative period.